RUSK Insights on Rehabilitation Medicine

Dr. Heidi Fusco is an assistant professor of Rehabilitation Medicine at NYU LANGONE Health and the Rusk Rehabilitation hospital. She is the Assistant Director of the Traumatic Brain Injury Program at Rusk and the Medical Director of the Brain Injury Unit at Queens Nassau Nursing and Rehabilitation. She completed a fellowship in Brain injury Rehab in 2013 at the Rusk Institute and is board certified in Brain Injury medicine and Physical Medicine and Rehabilitation.

Alaina B. Hammond is a board certified rehabilitation psychologist and currently serves as Clinical Assistant Professor and Staff Psychologist in the NYU Langone Rusk Adult Inpatient - Brain Injury Rehabilitation Program.  She provides psychological and neuropsychological intervention and assessment to patients and families with acquired brain injury, stroke, spinal cord injury and other illness/injuries. In addition, she supervises psychology interns and enjoys researching family/caregiver adjustment to medical illness. 

Dr. Jessica Rivetz is the current Brain Injury Medicine Fellow at NYU Rusk Rehabilitation. She recently completed her residency in physical medicine and rehabilitation at NYU Rusk. She received her MD degree at Albany Medical College, and also has a Master's of Science in health care management. Extracurricular activities include serving as co-chairperson of the NYU GME House Staff Patient Safety Council. Within brain injury medicine, she has a special interest managing patients with moderate to severe traumatic brain injury and helping them and their caregivers navigate life after brain injury and achieve their functional and quality of life goals.

Part 2

The discussion covered the following topics: persistence of sleep disorders and the role of physical exercise in treating them; definition of mindfulness; kinds of interventions included under the heading of mindfulness; examples of how it aims to address the severity of various TBI-related health problems; duration of mindfulness treatment; and self-compassion as another type of non-pharmacological intervention.

Dr. Heidi Fusco is an assistant professor of Rehabilitation Medicine at NYU LANGONE Health and the Rusk Rehabilitation hospital. She is the Assistant Director of the Traumatic Brain Injury Program at Rusk and the Medical Director of the Brain Injury Unit at Queens Nassau Nursing and Rehabilitation. She completed a fellowship in Brain injury Rehab in 2013 at the Rusk Institute and is board certified in Brain Injury medicine and Physical Medicine and Rehabilitation.

Alaina B. Hammond is a board certified rehabilitation psychologist and currently serves as Clinical Assistant Professor and Staff Psychologist in the NYU Langone Rusk Adult Inpatient - Brain Injury Rehabilitation Program.  She provides psychological and neuropsychological intervention and assessment to patients and families with acquired brain injury, stroke, spinal cord injury and other illness/injuries. In addition, she supervises psychology interns and enjoys researching family/caregiver adjustment to medical illness. 

Dr. Jessica Rivetz is the current Brain Injury Medicine Fellow at NYU Rusk Rehabilitation. She recently completed her residency in physical medicine and rehabilitation at NYU Rusk. She received her MD degree at Albany Medical College, and also has a Master's of Science in health care management. Extracurricular activities include serving as co-chairperson of the NYU GME House Staff Patient Safety Council. Within brain injury medicine, she has a special interest managing patients with moderate to severe traumatic brain injury and helping them and their caregivers navigate life after brain injury and achieve their functional and quality of life goals.

Part 1

The discussion covered the following topics: concussions and TBIs; pediatric care; use of biomarkers; common causes of a TBI; common symptoms and their length of duration; involvement of informal caregivers; and occurrence of sleep disorders.

Dr. Steven DeKosky is professor of Alzheimer’s research at the University of Florida College of Medicine and Deputy Director of the McKnight Brain Institute at that institution. He also is a professor of neurology and neuroscience there. Previously, he served as vice president and dean of the University of Virginia School of Medicine and was chairperson of the department of neurology at the University of Pittsburgh.

Part 2

For the short-term, with mild to moderate traumatic injury you can have altered synaptic structure and function. For the longer term, chronic inflammation and chronic oxidative stress can lead to subsequent degeneration and also some chronic microglial activation, which may turn on mechanisms that you do not necessarily want, including cleaning up partially injured neurons that may recover. Especially in patients who get the disease in an older age, there is other pathology in the CTE. There are nerve fibrillary tangle and Lewy body.  Amyloid beta can be elevated in both white matter and grey matter and might add to the cascade that is thought amyloid leads to, which leads to degeneration especially Alzheimer’s disease, but cannot prove it. Participants in contact sports all are at significant risk. APOE 4 increases the risk of Alzheimer’s disease and the risk of tau deposition. Currently, when patients arrive for rehabilitation, they are going to have things a lot better described than was the case previously.  We can look at disruption of structures, see hemorrhage and inflammation. We know that CTE is not a new disease, but we do see the pathology in other contact sports and we do not view it in autopsy series unless the individual had a history or repetitive head injury.

A Question & Answer period followed.

Dr. Steven DeKosky is professor of Alzheimer’s research at the University of Florida College of Medicine and Deputy Director of the McKnight Brain Institute at that institution. He also is a professor of neurology and neuroscience there. Previously, he served as vice president and dean of the University of Virginia School of Medicine and was chairperson of the department of neurology at the University of Pittsburgh.

Part 1

Dr. DeKosky described how CTE has a fascinating history, There still are questions about it. Some questions are old while some are new, but they all are interesting with respect to injury to the brain and how you try to repair it. Future directions also will be covered because the data arrive quickly. Mild traumatic brain injury usually means at least being knocked unconscious. It is not clear whether there is short-term pathology that lasts. Recovery usually is good. It is not clear exactly how much of an increased risk of Alzheimer’s disease there is with a single severe TBI while more is being learned about the long-term effects. Only recently has CTE been defined clearly. Boxing is where CTE came from initially. He indicated that football helmets first were used at the U.S. Naval Academy in 1894 because one player needed protection against experiencing another head injury. He mentioned that the NCAA owes its origins to efforts to reduce brutal injuries sustained by football players. President Theodore Roosevelt led governmental efforts to prevent such injuries. Several examples were provided of developments that occurred over the decades to obtain a greater understanding of the prevention and treatment of brain damage. Apart from head injuries in sports, an uptick in interest in such uncommon disorders resulted from modern day wars in the middle east involving blast injuries from IEDs and the discovery that playing football and other sports led to many injuries viewed as being more common.

The introduction is done by Dr. Steven Flanagan, Chairperson of the Department of Rehabilitation at NYU Langone Health. His remarks ended at the 2 minute: 24 second mark.

Dr. Darryl Kaelin is the Endowed Chair of Stroke and Brain Injury Rehabilitation at the University of Louisville. In this Grand Rounds session, he speaks about Traumatic Brain Injury and its Association with Neurodegenerative Disorders.

Part 2

Repetitive mild brain injuries also can result in the same kinds of findings. So, it is not just moderate to severe, but repetitive mild injuries that increase the risk. Although there may not be a direct causal relationship, certainly having a brain injury, multiple mild brain injuries or a moderate to severe brain injury increases the risk of developing neurodegenerative processes like Alzheimer’s and Parkinson’s.  He tells his patients that the likelihood of developing a neurodegenerative process may be there, but in each individual it can be different. We don’t know specifically what it might mean for you. On average the risk may go up, but it still is very small. He talked about some potential neuro-protective treatments that might exist out there or are in the process of being looked at. He stated that this patient population is heavily heterogeneous, especially in how it presents and responds to trauma. Additionally, patients in the U.S. don’t all receive exactly the same treatment after their trauma, which is a confounding variable that results in a very different outcome for each of those kinds of patients. Nutrition is a highly important factor when it comes to recovery and outcomes.  Parenteral nutrition goes a long way in helping their outcomes. It also is important to keep an eye on vitamin and mineral levels.  Zinc is a key supplement for many patients and magnesium can help in recovery. He closed by describing a disorders of consciousness program at his institution called the Emerge Program.

A Question &Answer period followed.

The introduction is done by Dr. Steven Flanagan, Chairperson of the Department of Rehabilitation at NYU Langone Health. 

Dr. Darryl Kaelin is the Endowed Chair of Stroke and Brain Injury Rehabilitation at the University of Louisville. In this Grand Rounds session, he speaks about Traumatic Brain Injury and its Association with Neurodegenerative Disorders.

Part 1

Dr. Kaelin described the interesting relationship between the University of Louisville Frazier Rehabilitation Institute and NYU Rusk in New York. The Institute has its origins at NYU. His presentation had a focus on cellular level and pathophysiology that contribute to complications of brain injury, Alzheimer’s type dementia, Parkinson’s Disease and some similarities that exist. He began a literature review one-year ago on this topic, which has led to today’s discussion. It is important to start by talking a little about the pathophysiology TBI and cerebral insults. It can have some correlation to stroke and other insults to the brain and central nervous system. He also talked a little bit about things that we don’t think about much as physiatrists –astrocytes and microglia and what their roles are in the brain and in brain trauma. He indicated that astrocytes are the scaffolding or the structure upon which neurons and other cells hold themselves to and create the structure and shape of the brain. Microglial cells help in brain infection and brain inflammation. In a resting, healthy brain they are highly mobile and will undergo morphological changes following a brain trauma. He indicated that synapses between neurons are significantly affected both mechanically and in becoming lost in severe brain injury. He discussed the importance of sleep for patients with a brain injury.

Dr. Julie Silver is an associate professor and associate chairperson in the department of physical medicine and rehabilitation at Harvard Medical School

PART 2

In Part 2, Dr. Silver began by indicating that thinking about belonging and social integration are super important. There are two bodies of literature--a retention literature and a belonging literature. Very few studies have looked at them together. One investigation that did so found that women who have fewer belonging components are more likely to leave their workplace and more likely to stay if they have more of these components. What can be done right now to improve the situation? Her answer is that individuals should be told that they belong. Inclusion is not a synonym of belonging. She provided examples of constructive steps that have been implemented at other academic institutions. Mentoring is a critically important model. She described how she works with individuals in helping them to feel that they belong and indicated five strategies that leaders can implement. Let’s not assume that progress happens. Instead, let’s believe the science and follow the data. When looking at the proportion of women on specialty boards, they found in a comparison study that six boards decreased and that two stayed the same. Progress does not just happen on its own. In PM&R, there was an increase, but it still is not really at the equitable level.  We must continue to focus on it. The same holds true when looking at race and ethnicity.

Dr. Julie Silver is an associate professor and associate chairperson in the department of physical medicine and rehabilitation at Harvard Medical School

PART 1

Her presentation is a data-driven lecture for individuals who believe in science.  A big theme in her work is to focus on tipping points that will drive change faster. An important large study reported in the journal Lancet in 2018 attracted widespread attention. Researchers looked at clinical practice guidelines. They found that the representation of female authors was low, but even lower for female physicians. Looking at PM&R since then shows similar findings. Problems were not being solved because while medical societies indicated that they were not at fault, their journals expressed the same opinion. It became obvious that many organizations were working together in ways that were complicit. Not many women were included in the clinical practice guidelines. Compensation is an important issue that also was studied extensively. Dr. Silver provided an example of how men were compensated more than women for performing similar procedures. She discussed medical recognition awards that also reveal a considerable amount of disparity that favors men over women. The same holds true for minoritized groups as explained using the concept of inexorable zero. A promotion problem is involved in this situation, which can be fixed. Additionally, her lecture also focused on challenges pertaining to faculty retention. Women physicians are more likely to leave academia at all career stages.  A key issue is enabling individuals to feel that they belong.

Nicole Lund is a registered dietitian at NYU Langone’s Sports Performance Center. A certified health and well-being coach and certified personal trainer, as a former dancer her love of movement led her into a career as a step aerobics instructor and personal trainer. Through her work, she recognized a need for a discussion about food and its impact on everything from performance to health. She sees medical nutrition therapy patients via insurance and self-pay sports. She is a clinician with the Running Lab and works with athletes on the USA Nordic team.

Her expertise is in sports and performance nutrition while her clinical interests include chronic inflammation, weight loss, migraines, and menopause. She has a master’s degree in public health nutrition from Hunter College.

Part 2

The discussion covered the following topics: complementary and alternative therapies; accuracy of patients' nutrition knowledge; influence of demographic factors on the adequacy of nutritional status; provision of nutritional health care care via telehealth; prevention of health problems related to participating in vigorous physical activities; and how improved dietary practices may help to prevent health problems.

Nicole Lund is a registered dietitian at NYU Langone’s Sports Performance Center. A certified health and well-being coach and certified personal trainer, as a former dancer her love of movement led her into a career as a step aerobics instructor and personal trainer. Through her work, she recognized a need for a discussion about food and its impact on everything from performance to health. She sees medical nutrition therapy patients via insurance and self-pay sports. She is a clinician with the Running Lab and works with athletes on the USA Nordic team.

Her expertise is in sports and performance nutrition while her clinical interests include chronic inflammation, weight loss, migraines, and menopause. She has a master’s degree in public health nutrition from Hunter College.

Part 1

The discussion covered the following topics: how and when she began to develop an interest in performance nutrition; types of patients she treats; the role that diet plays in improving problems involving overweight and obesity; and use of dietary supplements by patients. 

Dr. David Jevotovsky is in the second year of a residency program at the Rusk Rehabilitation Institute at NYU Langone Health. A former graduate of NYU Grossman School of Medicine, he is keen on pursuing a fellowship in interventional pain medicine. Having experienced a traumatic brain injury during his medical training, he possesses a unique understanding of both the patient and provider perspectives of this condition.

As patients differ on the basis of age, gender, and racial/ethnic background,  whether they also tend to differ in how they express what it is like to experience a TBI and live with its aftermath; the role played by social media in the residency program; whether beneficial outcomes can result from having patients with a TBI participate in physical exercise activities; why it is hard for many patients, their loved ones, and even PM&R physicians to understand how a brain could be rewired; and different perspectives that patients and physicians may have regarding agitation/delirium, cognition, return to work, and support systems. 

This unique episode features course directors Dr. Salvador Portugal, Dr. Surein Theivakumar, Dr. Julia Iafrate, Dr. Jina Libby and Dr. Haruki Ishii for the course taking place 6/7-6/9.

The following link has more information, if you or anyone you know is interested in registering: https://www.pathlms.com/nyurusk/courses/66458.

Dr. Jina Libby completed her PM&R residency in Michigan. Her dedication to that profession and sports medicine extends beyond clinical practice as she serves on the executive committee for the International Rehab and Global Health Committee of AAPM&R. Her fervor for education is evident through her commitment to teaching physical medicine and rehabilitation, not only locally, but also by championing its integration on an international scale.

Beyond her current role as a fellow physician, Dr. Laurenie Louissaint's compassionate spirit leads her on frequent global impact trips, where she provides critical medical support to underserved communities, such as Haiti and Namibia. She also is an active member of the New York City cycling community while also providing medical care for injured cyclists and developing related research.

Part 1

The discussion in Part 1 included the following items: demographic aspects of Namibia, major health problems in that nation, how health care is financed, similarities with western allopathic health practices, use of traditional and alternative health care interventions, status of health professions educational institutions, and nature of the auspices sponsoring the visitation trip by U.S. clinicians to that country.

Part 2

The discussion in Part 2 included the following items: types of health professionals in the group visiting Namibia, kinds of Namibian practitioners interacted with during the visit, most evident aspects of health care in that nation where improvements would appear to be beneficial, possibly reversing the flow of clinicians to enable Namibians to spend time in U.S. clinical facilities, and health professional literature produced in that country.

Dr. Jina Libby completed her PM&R residency in Michigan. Her dedication to that profession and sports medicine extends beyond clinical practice as she serves on the executive committee for the International Rehab and Global Health Committee of AAPM&R. Her fervor for education is evident through her commitment to teaching physical medicine and rehabilitation, not only locally, but also by championing its integration on an international scale.

Beyond her current role as a fellow physician, Dr. Laurenie Louissaint's compassionate spirit leads her on frequent global impact trips, where she provides critical medical support to underserved communities, such as Haiti and Namibia. She also is an active member of the New York City cycling community while also providing medical care for injured cyclists and developing related research.

Part 1

The discussion in Part 1 included the following items: demographic aspects of Namibia, major health problems in that nation, how health care is financed, similarities with western allopathic health practices, use of traditional and alternative health care interventions, status of health professions educational institutions, and nature of the auspices sponsoring the visitation trip by U.S. clinicians to that country.

Part 2

The discussion in Part 2 included the following items: types of health professionals in the group visiting Namibia, kinds of Namibian practitioners interacted with during the visit, most evident aspects of health care in that nation where improvements would appear to be beneficial, possibly reversing the flow of clinicians to enable Namibians to spend time in U.S. clinical facilities, and health professional literature produced in that country.

Dr. Sharon Kolasinski is a professor of clinical medicine at the University of Pennsylvania and chief of the Division of Rheumatology at Penn Presbyterian Medical Center.

Part 1

Her objectives in the presentation are to help listeners by learning about evidence-based treatment for patients with osteoarthritis (OA), to understand the process by which guidelines are developed that might help us figure out our evidence-based approach, to review the recommended treatments for OA, and to review some treatments that are not recommended for OA. Her basic evidence-based reference is a University of Pennsylvania guideline that was published in 2020. Numerous other guidelines are available, which she described. She discussed her work with a case involving a 55-year-old male patient. He arrived for routine follow-up care for immunosuppressive medication monitoring. He described pains that he was experiencing and was diagnosed with OA. She indicated the impacts OA has on patients. Clinicians find it a daunting challenge to provide satisfactory treatment. For example, for some clinicians, the guidelines do not appear to be clear and provide a roadmap. Also, they do not always believe in the recommendations contained in the guidelines. In this presentation, she wants to see if she can change some minds about guidelines. She provided an example based on investigations conducted at her institution. The outcome was a series of recommendations that she described.

Part 2

Dr. Kolasinski began Part 2 of her presentation by continuing to focus on the importance of having patients with OA engage in physical activity. She stated that “they are worn out and the implication is that a doctor is needed to fix them.” Perhaps a perspective should be taken of a more participatory discourse where we encourage physical therapy and emphasize that physical exercise is safe when you have arthritis and focus on what the patient can do, empowering them to exercise. A starting point is to give patients a physical therapy prescription. She discussed the extent to which physical therapy is useful, along with indicating how much and how frequently exercise is beneficial (e.g., for 20 minutes, three times a week). Losing weight is an effective way of reducing symptoms. Food choices can affect OA symptoms. Diet and exercise used together can produce effective results. References were made to several studies that involve the status of steroid injections on improving patient health status. Acupuncture also was mentioned. She indicated conditional recommendations on the use of pharmacological interventions. She concluded by describing how to treat the 55-year-old patient she mentioned in Part 1 of her presentation.

Dr. Sharon Kolasinski is a professor of clinical medicine at the University of Pennsylvania and chief of the Division of Rheumatology at Penn Presbyterian Medical Center.

Part 1

Her objectives in the presentation are to help listeners by learning about evidence-based treatment for patients with osteoarthritis (OA), to understand the process by which guidelines are developed that might help us figure out our evidence-based approach, to review the recommended treatments for OA, and to review some treatments that are not recommended for OA. Her basic evidence-based reference is a University of Pennsylvania guideline that was published in 2020. Numerous other guidelines are available, which she described. She discussed her work with a case involving a 55-year-old male patient. He arrived for routine follow-up care for immunosuppressive medication monitoring. He described pains that he was experiencing and was diagnosed with OA. She indicated the impacts OA has on patients. Clinicians find it a daunting challenge to provide satisfactory treatment. For example, for some clinicians, the guidelines do not appear to be clear and provide a roadmap. Also, they do not always believe in the recommendations contained in the guidelines. In this presentation, she wants to see if she can change some minds about guidelines. She provided an example based on investigations conducted at her institution. The outcome was a series of recommendations that she described.

Part 2

Dr. Kolasinski began Part 2 of her presentation by continuing to focus on the importance of having patients with OA engage in physical activity. She stated that “they are worn out and the implication is that a doctor is needed to fix them.” Perhaps a perspective should be taken of a more participatory discourse where we encourage physical therapy and emphasize that physical exercise is safe when you have arthritis and focus on what the patient can do, empowering them to exercise. A starting point is to give patients a physical therapy prescription. She discussed the extent to which physical therapy is useful, along with indicating how much and how frequently exercise is beneficial (e.g., for 20 minutes, three times a week). Losing weight is an effective way of reducing symptoms. Food choices can affect OA symptoms. Diet and exercise used together can produce effective results. References were made to several studies that involve the status of steroid injections on improving patient health status. Acupuncture also was mentioned. She indicated conditional recommendations on the use of pharmacological interventions. She concluded by describing how to treat the 55-year-old patient she mentioned in Part 1 of her presentation.

Dr. Natalie Azar is an Associate Clinical Professor of Medicine & Rheumatology at NYU Langone Health. Certified by the American Board of Internal Medicine, she is a designated long Covid provider in rheumatology. Her practice locations are at the Langone orthopedic center and Washington Square, and she has been in private practice since 2001. A graduate of Wellesley College, Dr. Azar’s medical degree is from Cornell University Medical College. She completed her internship, residency, and fellowship at New York University. Her fellowship in rheumatology was at the Hospital For Joint Diseases. She has been a medical contributor to NBC News since 2014.

Part 1

The discussion in Part 1 included the following items: clinical definition of Long-COVID; predictability of developing Long-COVID; whether patients with existing rheumatic disease are more susceptible to developing Long-COVID; whether COVID-19 could trigger rheumatic disease; differences and similarities between Long-COVID and rheumatic disease; whether Long-COVID can occur following mild acute illness; risk factors associated with developing Long-COVID; presence of fatigue as a risk factor for developing Long-COVID; and major symptoms of Long-COVID.

Part 2

The discussion in Part 2 included the following items: organ systems and tissues most affected by Long-COVID; variations in symptoms and disease severity among patients; diagnostic and prognostic biomarkers for Long-COVID; protective effects of vaccine; episodic aspects of Long-COVID; use of medications and non-pharmaceutical treatment interventions; and personal and NYU involvement in conducting Long-COVID studies.

Dr. Natalie Azar is an Associate Clinical Professor of Medicine & Rheumatology at NYU Langone Health. Certified by the American Board of Internal Medicine, she is a designated long Covid provider in rheumatology. Her practice locations are at the Langone orthopedic center and Washington Square, and she has been in private practice since 2001. A graduate of Wellesley College, Dr. Azar’s medical degree is from Cornell University Medical College. She completed her internship, residency, and fellowship at New York University. Her fellowship in rheumatology was at the Hospital For Joint Diseases. She has been a medical contributor to NBC News since 2014.

Part 1

The discussion in Part 1 included the following items: clinical definition of Long-COVID; predictability of developing Long-COVID; whether patients with existing rheumatic disease are more susceptible to developing Long-COVID; whether COVID-19 could trigger rheumatic disease; differences and similarities between Long-COVID and rheumatic disease; whether Long-COVID can occur following mild acute illness; risk factors associated with developing Long-COVID; presence of fatigue as a risk factor for developing Long-COVID; and major symptoms of Long-COVID.

Part 2

The discussion in Part 2 included the following items: organ systems and tissues most affected by Long-COVID; variations in symptoms and disease severity among patients; diagnostic and prognostic biomarkers for Long-COVID; protective effects of vaccine; episodic aspects of Long-COVID; use of medications and non-pharmaceutical treatment interventions; and personal and NYU involvement in conducting Long-COVID studies.

Dr. Jacques Hacquebord is  Chief of Hand and Upper Extremity Surgery at NYU Langone Health. He also serves as the co-chief of the Hand Surgery service at Bellevue Hospital (a Level 1 trauma and regional replant center) and co-chief of the Center for Amputation Reconstruction. He did his surgical residency in orthopedic surgery at the University of Washington and the world-renowned trauma center Harborview Medical Center and did his fellowship in Hand/Microsurgery at the University of California at Irvine with Dr Neil Jones. He then completed two traveling fellowships in reconstructive microsurgery and brachial plexus surgery with the first in China and then the second at Ganga Hospital in India. His principal clinical interest and passion within hand and orthoplastic surgery is the primary management and secondary reconstruction of the traumatized upper extremity. This includes replantation surgery, reconstruction of bone and soft tissues deficits in the upper extremity, and complex nerve reconstruction surgery. 

The discussion in Part 2 included the following items: other types of clinicians who provide treatment for patients who need hand surgery; influence of artificial intelligence (AI) on hand surgery; complications that could arise during hand surgery and how to mitigate them; management of post-operative pain; dealing with pre-operative anxiety experienced by patients; quality of patient information on the Internet about hand health problems; advice on how to prevent health problems regarding the hands; personal lessons learned that have implications for improving patient care; and research involvement at NYU Langone Health.

Dr. Jacques Hacquebord is  Chief of Hand and Upper Extremity Surgery at NYU Langone Health. He also serves as the co-chief of the Hand Surgery service at Bellevue Hospital (a Level 1 trauma and regional replant center) and co-chief of the Center for Amputation Reconstruction. He did his surgical residency in orthopedic surgery at the University of Washington and the world-renowned trauma center Harborview Medical Center and did his fellowship in Hand/Microsurgery at the University of California at Irvine with Dr Neil Jones. He then completed two traveling fellowships in reconstructive microsurgery and brachial plexus surgery with the first in China and then the second at Ganga Hospital in India. His principal clinical interest and passion within hand and orthoplastic surgery is the primary management and secondary reconstruction of the traumatized upper extremity. This includes replantation surgery, reconstruction of bone and soft tissues deficits in the upper extremity, and complex nerve reconstruction surgery. 

The discussion in Part 1 included the following items: reason for deciding to practice in hand surgery; common health problems that result in patients undergoing hand surgery, influence of gender on the onset of health problems, kinds of health problems children experience, patient expectations of what will result from hand surgery, use of wide-awake local anesthesia no tourniquet surgery (WALANT), and patients’ level of cooperation in achieving positive surgical outcomes.

A special two-part Grand Rounds presentation by Dr. Carlo Pardo, who is a clinical neurologist/pathologist and professor of neurology and pathology at the Johns Hopkins School of Medicine.

Part Two

Getting the clinical information, the temporal profile of the patient, along with MRI findings and spinal fluid analysis is important during the analysis of patients presenting with myelopathic syndromes. MRI is one important tool and a very good way to establish the magnitude and localization of spinal cord lesions. One thing he likes to emphasize also is that the presence of myelopathies are not following the classical territories that we know. One thing that is important is that in addition to the blood supply is the blood drainage. The blood drainage of the spinal cord once again is very complex and there is a good and complex pattern of drainage at every segment of the spinal cord. He emphasized for individuals working in rehabilitation that there are other areas of the blood supply that may be affected. Some examples were provided of what he meant. He discussed experiences in their analysis of some cases at his institution where they analyzed 125 patients, attempting to classify the topographic distribution of the lesion.

A special two-part Grand Rounds presentation by Dr. Carlo Pardo, who is a clinical neurologist/pathologist and professor of neurology and pathology at the Johns Hopkins School of Medicine.

Part One

He began by stating that the main objective of this presentation is understanding the concept of myelopathies versus myelitis. He wants to present a diagnostic approach for the evaluation of a patient with an acute case of myelopathy and vascular myelopathy, and review the current concepts of vascular myelopathies, something that probably will be encountered very often in rehabilitation clinical practice. It is truly important that after this lecture to stop using the term myelitis and instead use a more precise etiological diagnosis of myelopathy. He disclosed where his research funding comes from. He presented a historical concept of myelitis and myelopathies. In the past several years, the major revolution in neurology has been the discovery of many biomarkers that are identified myelopathies. Etiological diagnosis should dominate the evaluation of patients with acute myelopathies because once we identify the etiological factor, we are able to help those patients in a better way. A lack of proper characterization may lead to mistreatment. A major difficulty in assessment of non-inflammatory myelopathy is at this moment, we do not have clear criteria to diagnose some of them. So keep in mind that the temporal assessment of the lesion by MRI is also important and you need to think about the timing of the MRI when you are preparing to give an interpretation to decide what is a potential etiological diagnosis.

In this episode, the two discuss how and when they began to develop an interest in performing arts medicine; health screening of performers prior to participation in these activities; failure to admit the existence of a health problem because of a fear of being replaced by a healthier performer; types of clinicians involved in treating performing artists; and approaches to preventing health problems in performing artists.

Dr. Tracy McKay is a Clinical Assistant Professor in the Department of Rehabilitation Medicine at NYU Grossman School of Medicine.  She specializes in Integrative Sports and Spine Medicine with a special interest in Performing Arts Medicine. Dr. McKay is Chairperson of the Performing Arts Medicine Community of the American Academy of Physical Medicine and Rehabilitation and served as consulting medical director for the Broadway show, Here Lies Love. She is a staff physician at the Harkness Center for Dance Injuries and provides care to professional dance companies that include Complexions, Alvin Ailey, Ballet Hispanico, and AIM. 

Dr. Rosa Pasculli is a non-operative Sports Medicine physician at Emory Orthopedics at Grady Health System in Atlanta. Her primary clinical area of interest is performing arts medicine. She serves as a consulting physician for the Atlanta Ballet, the Georgia Ballet, and she is a faculty member of the Female Athlete Program. She also serves as a team physician for Emory University, the College Park Skyhawks, and several Atlanta high schools. Dr. Pasculli completed medical school at New York University School of Medicine and her residency was in Physical Medicine and Rehabilitation at NYU. She also had a fellowship in Primary Care Sports Medicine at Emory University.

We should begin with every patient by validating that their pain is real. He discussed the role played by cognitive behavioral therapy (CBT). It is referenced most often because it has the best evidence, but we do not really know how to break that down for patients. He described three basic stages. It is important to recognize that CBT is not the best and only treatment. Exercise is important in a lot of musculoskeletal conditions, but it should be tailored to benefit that window between benefit and symptom aggravation. Next, is the question of what must be done with all the information he has provided in this presentation thus far. There seems to be evidence of some advantage to participating in athletics or being fit. Also, not everyone who is fit is having a good time and not everyone with a chronic condition can jump into fitness in the right way. So, we need to figure out how to meld that. Patients come to us because they are suffering. We need a team approach to close the performance gap they experience. A psychological battle must be dealt with at the same time as physical problems. He described strategies he would use. Find out what exercise they do now and for how many minutes, and their amount of sleep. Determine what they enjoyed doing in the past. It is important to focus on one of their problems and aim to achieve success in treating it. He described some available resources that are useful.

A Question & Answer period followed.

PART 1

Dr. Vasudevan began by discussing how pain is experienced by athletes and non-athletes, how to identify components of multidisciplinary care for both those groups, and incorporate some reasonable strategies that might help with exercise prescriptions and lifestyle modifications for those with chronic pain. He provided some definitions for various terms, such as pain medicine, sports medicine, and pain. The latter is in the brain, which is the summation of all inputs. As physiatrists, we look at what the pain is keeping you from doing what you want to perform. He addressed the question of whether there are gender differences in the perception of pain. The short answer is no. Strength and endurance matter more. Endurance athletes can tolerate pain better. He discussed some consequences of the overtraining syndrome. If an athlete cannot perform at a desired level, there is a higher mental risk. Insufficient sleep is a risk factor. A pertinent concern is how to improve mental health in athletes. He indicated what they do at Penn to address this matter. Non-pharmacological interventions are preferred for treating injuries, e.g., massage modalities. The use of topical medications can be effective from a systemic perspective. The discussion then switched to chronic pain. 

Holly Cohen is the program manager of assistive technology and the driving rehabilitation program at NYU Langone Health. She is an Occupational Therapist with over 25 years of experience. She also is an adjunct professor at New York University where she teaches occupational therapy and engineering students on the importance of accessibility and adaptability in everyday technology.  Additionally, she has lectured both nationally and internationally on the importance of assistive technology to improve function and quality of life for users.

The following items were discussed in Part 1: Determining the ability of patients to use various forms of assistive technology; examples of the kinds of assistive technology employed in providing care to patients; kinds of patients treated; treatment offered in the clinical setting and by telehealth; if patients ever abandon using assistive devices; whether patients influence the kinds of assistive technology used; use of a patient group-based treatment approach; emerging technology; and key lessons learned in improving patient care. 

This is an exciting year for RUSK, celebrating our 75th anniversary! As part of our celebration, we are hosting a number of events including our Research Symposium, podcasts, and interviews. Our content continues to cover a wide range of topics within PM&R, and this particular segment includes special Rusk 75th Anniversary episodes featuring Rusk leadership, faculty, and residents.

This is the third of three special episodes...

Dr. Lindsey Gurin specializes in Dementia & Alzheimer's, Neuropsychiatry and is Assistant Professor, Department of Neurology at NYU Grossman School of Medicine, an Assistant Professor, Department of Psychiatry at NYU Grossman School of Medicine ,and an Assistant Professor, Department of Rehabilitation Medicine at NYU Grossman School of Medicine She is also Director of both the  Neurology/Psychiatry Residency Program and Behavioral Neurology, NYU Langone Orthopedics Hospital.

Dr. Prin Amorapanth is an Assistant Professor, Department of Rehabilitation Medicine at NYU Grossman School of Medicine . He completed his residency at the Rehabilitation Institute of Chicago, Rehab Medicine and his fellowship at NYU Langone Medical Center, Brain Injury Medicine. 

Dr. Jessica Rivetz is currently a resident physician in Physical Medicine and Rehabiitation at NYU Grossman School of Medicine and will be applying for her fellowship in brain injury medicine. 

This is an exciting year for RUSK, celebrating our 75th anniversary! As part of our celebration, we are hosting a number of events including our Research Symposium, podcasts, and interviews. Our content continues to cover a wide range of topics within PM&R, and this particular segment includes special Rusk 75th Anniversary episodes featuring Rusk leadership, faculty, and residents.

This is the second of three special episodes...

Dr. Jonathan Whiteson is Assistant Professor, Department of Rehabilitation Medicine; Assistant Professor, Department of Medicine; Medical Director of Rusk Outreach and Growth; and Medical Director of Cardiac Rehabilitation. His research interests include: cardiac and pulmonary rehabilitation coping strategies during cardiac rehabilitation following cardiac surgery, pulmonary rehabilitation of individuals exposed to world trade center dust, and recognizing encephalopathy and delirium in the cardiopulmonary rehabilitation setting. He is also part of the Senior Leadership team of Rusk Institute and Medical Director of the Rusk Institute Outpatient program.

This is an exciting year for RUSK, celebrating our 75th anniversary! As part of our celebration, we are hosting a number of events including our Research Symposium, podcasts, and interviews. Our content continues to cover a wide range of topics within PM&R, and this particular segment includes special Rusk 75th Anniversary episodes featuring Rusk leadership, faculty, and residents.

This is the first of three special episodes...

Steven Flanagan, MD is professor and chairman of the Department of Rehabilitation Medicine, New York University School of Medicine, and the medical director of the Rusk Institute of Rehabilitation Medicine, New York University Langone Medical Center. Dr. Flanagan has served on medical advisory boards of many national and international committees and has presented at scientific meetings both nationally and internationally, most notably on topics pertaining to brain injury rehabilitation. He has authored numerous chapters and publications and has participated in both federally and industry sponsored research, funded by such organization as the National Institute on Aging.

Dr. Jonathan Whiteson is Assistant Professor, Department of Rehabilitation Medicine; Assistant Professor, Department of Medicine; Medical Director of Rusk Outreach and Growth; and Medical Director of Cardiac Rehabilitation. His research interests include: cardiac and pulmonary rehabilitation coping strategies during cardiac rehabilitation following cardiac surgery, pulmonary rehabilitation of individuals exposed to world trade center dust, and recognizing encephalopathy and delirium in the cardiopulmonary rehabilitation setting. He is also part of the Senior Leadership team of Rusk Institute and Medical Director of the Rusk Institute Outpatient program.

Dr. Weiss is Professor of Rehabilitation Medicine at the NYU Long Island School of Medicine. She previously was the Chairman and Director of Residency Training for the Department of Physical Medicine and Rehabilitation at Nassau University Medical Center. She also was the Director of Electrodiagnostic Medicine and Chair of the Ethics committee. She is Board Certified in both Physical Medicine and Rehabilitation and Electrodiagnostic Medicine and in November 2018 was among the first group of professionals to become Healthcare Ethics Consultant-Certified. Dr. Weiss has published numerous articles, book chapters, and authored 10 books. She is active in professional organizations on a national level. Her professional interests include electrodiagnostic medicine, ethics, and women in medicine.

The following items were discussed in Part 2: 

Differences between monopolar and concentric needles; possible role of contaminants leading to diagnostic misinterpretation; training or certification required to become eligible to engage in EMG testing; kinds of clinical personnel who conduct EMG tests; size of the workforce engaged in EMG testing; the role of EMG wearables by patients; future studies of EMG testing; and personal current research involvement.

Dr. Weiss is Professor of Rehabilitation Medicine at the NYU Long Island School of Medicine. She previously was the Chairman and Director of Residency Training for the Department of Physical Medicine and Rehabilitation at Nassau University Medical Center. She also was the Director of Electrodiagnostic Medicine and Chair of the Ethics committee. She is Board Certified in both Physical Medicine and Rehabilitation and Electrodiagnostic Medicine and in November 2018 was among the first group of professionals to become Healthcare Ethics Consultant-Certified. Dr. Weiss has published numerous articles, book chapters, and authored 10 books. She is active in professional organizations on a national level. Her professional interests include electrodiagnostic medicine, ethics, and women in medicine.

The following items were discussed in Part 1: 

Reason for deciding to practice in PM&R; some indications for electrodiagnostic testing; difference between nerve conduction studies and EMG; most common health problems that govern EMG testing; kinds of musculature tested; how electrodiagnostic testing differs from MRIs and x-rays; if patient age affects EMG tests; diagnostic information furnished by needle insertion and placement of electrodes over the skin surface; and patient characteristics to take into account when inserting needles.

Dr. Tan participated in a Dual Residency Program in Physical Medicine and Rehabilitation/Pediatrics at Long Island Jewish Medical Center in New Hyde Park, New York. She has received Fellowship Grants and Support from the Christopher Reeve Foundation, the  Medtronics/Allergan: Spasticity Management Workshop, and the Starlight Children’s Foundation. She served as Founder of the Philippine Chinese-American Medical Association and became President of that organization in 2014. Dr. Tan obtained her medical degree from the Faculty of Medicine and Surgery at the University of Santo Tomas in Manila, Philippines.

The following items were discussed in Part 2: role played by family in providing care; outcomes produced when treating with botox; implementation of alcohol blocks in treatment; what serial casting in treatment entails; use of oral medications; role played by complementary and alternative modalities; whether symptoms change with age; the transition from pediatric to adult care; potential of big data, machine learning, and artificial intelligence in treating patients with cerebral palsy; and her research interests in cerebral palsy and plans to be involved in any upcoming investigations.

Dr. Tan participated in a Dual Residency Program in Physical Medicine and Rehabilitation/Pediatrics at Long Island Jewish Medical Center in New Hyde Park, New York. She has received Fellowship Grants and Support from the Christopher Reeve Foundation, the  Medtronics/Allergan: Spasticity Management Workshop, and the Starlight Children’s Foundation. She served as Founder of the Philippine Chinese-American Medical Association and became President of that organization in 2014. Dr. Tan obtained her medical degree from the Faculty of Medicine and Surgery at the University of Santo Tomas in Manila, Philippines.

The following items were discussed in Part 1: how she decided to become a pediatrician specializing in cerebral palsy; what causes cerebral palsy; if heredity plays a role; likelihood of any demographic factors involved in the onset of this condition; tools and practices used in early diagnosis; types of cerebral palsy; whether it can be acquired after birth; preventability; incidence of cerebral palsy in the U.S.; conditions other than neurological and gross motor disorders that affect these patients; and the kinds of team members engaged in furnishing treatment.

Dr. Morris currently works full-time as a researcher. She is founder and director of the Disability Equity Collaborative where her work focuses on provider and health care organization-level factors that negatively impact the quality of care delivered to patients with disabilities. Her work has been funded by the NIH and other key sources of support. She has published in major medical periodicals, including the New England Journal of Medicine and the journal Health Affairs. Dr. Morris has a Masters of Science degree in Speech-Language Pathology, a Masters of Public Health degree, and a PhD in Rehabilitation Sciences from the University of Washington. She completed post-doctoral fellowships at Northwestern University and the Mayo Clinic in health services research. She has served as a faculty member at the Mayo Clinic, Harvard Medical School, and the University of Colorado Medical School.

The following items were discussed in Part 2: how ableism, including structural ableism appear in the healthcare setting; how medicine, including the field of rehabilitation, contributed to ableism in society; the importance of having health care organizations systematically collect and record patients’ disability status within the electronic health record; challenges in achieving effective documentation in the record and how to overcome them; how to determine patients’ needed disability accommodations and implementing them into routine clinical and hospital care; and any ongoing studies in which she is involved and anticipates undertaking in the near term.

Dr. Morris currently works full-time as a researcher. She is founder and director of the Disability Equity Collaborative where her work focuses on provider and health care organization-level factors that negatively impact the quality of care delivered to patients with disabilities. Her work has been funded by the NIH and other key sources of support. She has published in major medical periodicals, including the New England Journal of Medicine and the journal Health Affairs. Dr. Morris has a Masters of Science degree in Speech-Language Pathology, a Masters of Public Health degree, and a PhD in Rehabilitation Sciences from the University of Washington. She completed post-doctoral fellowships at Northwestern University and the Mayo Clinic in health services research. She has served as a faculty member at the Mayo Clinic, Harvard Medical School, and the University of Colorado Medical School.

The following items were discussed in Part 1: her definition of the term ableism; meaning of the term structural ableism and how it is manifested in society; whether there can be a tendency for ableism to occur in conjunction with another kind of ism, such as racism; and how she developed an interest in focusing on the topic of ableism.

Akhila Veerubhotla is an Assistant Professor in the Department of Rehabilitation Medicine at NYU-Grossman School of Medicine. She completed her post-doctoral fellowship jointly at the Center for Mobility and Rehabilitation Engineering at the Kessler Foundation and in the Department of Physical Medicine and Rehabilitation at Rutgers – New Jersey Medical School. She has a PhD in Rehabilitation Science from the University of Pittsburgh and a Masters degree in Biomedical Engineering from Carnegie Mellon University. Her research focuses on using technology to help improve mobility, balance, and physical activity in individuals with neurological impairments. Her work primarily is focused toward individuals with stroke, traumatic brain injury and spinal cord injury. 

The following items were discussed in Part 2: a Novel Core Strengthening Intervention for Improving Trunk Function, Balance and Mobility after a Stroke; variability in interventions may occur when therapists also provide assistance; risk of falls in individuals with traumatic brain injury; effectiveness of treadmills in conducting research that produces accurate measurements regarding falls; inclusion in studies of patients who have a communication disability as a result of a stroke; funding sources for studies involving technological devices in rehabilitation; role of artificial intelligence in rehabilitation research; and current studies underway or planned for the near future.

Akhila Veerubhotla is an Assistant Professor in the Department of Rehabilitation Medicine at NYU-Grossman School of Medicine. She completed her post-doctoral fellowship jointly at the Center for Mobility and Rehabilitation Engineering at the Kessler Foundation and in the Department of Physical Medicine and Rehabilitation at Rutgers – New Jersey Medical School. She has a PhD in Rehabilitation Science from the University of Pittsburgh and a Masters degree in Biomedical Engineering from Carnegie Mellon University. Her research focuses on using technology to help improve mobility, balance, and physical activity in individuals with neurological impairments. Her work primarily is focused toward individuals with stroke, traumatic brain injury and spinal cord injury. 

The following items were discussed in Part 1: whether devices used in her studies also are available commercially for patients to use at home; a systematic review study involving wearable devices for tracking physical activity in the community after an acquired brain injury; why the transition of wearable devices from the laboratory to the community has gained momentum slowly in recent years; and the value of having a wider representation of participants from different population subgroups in clinical studies.

Dr. Kathleen Isaac is a licensed Clinical Psychologist and Clinical Assistant Professor at NYU Langone Health. As a Haitian-American, cis-gender female, she directs the Medical Student and House Staff Mental Health program, which provides individual, couples, and group psychotherapy to medical students, residents, and fellows. She also has a part-time private practice focused on serving BIPOC and LGBTQ+ clients with integrative treatment approaches, where she specializes in trauma, health psychology, and cultural issues. Dr. Isaac also is an adjunct lecturer in the City College of New York’s doctoral program in clinical psychology where she teaches an advanced practicum on intersectional therapy and a Group Psychotherapy course. She has been featured on multiple media platforms, including NBC and the New York Times. Recently, she has published in the journal Psychiatry Annals and in a book chapter dealing with Her Clients’ Racial Identity Development During the Pandemic and the Black Lives Matter Movement.

The following items were discussed in Part 2: whether NYU offers any standardized screening to identify residents who may be struggling with mental health and burnout concerns; if NYU has a mentorship program for residents; kinds of differences that may occur in the types of pressures and challenges that may arise depending on the medical specialty; cultivating resilience to increase an ability to cope with various everyday pressures; and enhancing self-management skills in self-monitoring, recognizing, and reporting symptoms of any mental health problems.

Dr. Kathleen Isaac is a licensed Clinical Psychologist and Clinical Assistant Professor at NYU Langone Health. As a Haitian-American, cis-gender female, she directs the Medical Student and House Staff Mental Health program, which provides individual, couples, and group psychotherapy to medical students, residents, and fellows. She also has a part-time private practice focused on serving BIPOC and LGBTQ+ clients with integrative treatment approaches, where she specializes in trauma, health psychology, and cultural issues. Dr. Isaac also is an adjunct lecturer in the City College of New York’s doctoral program in clinical psychology where she teaches an advanced practicum on intersectional therapy and a Group Psychotherapy course. She has been featured on multiple media platforms, including NBC and the New York Times. Recently, she has published in the journal Psychiatry Annals and in a book chapter dealing with Her Clients’ Racial Identity Development During the Pandemic and the Black Lives Matter Movement.

Dr. Salvador Portugal is an Assistant Professor in the Dapartment of Rehabilitation Medicine at NYU Grossman School of Medicine. He is also Director of the Sports Fellowship program and Medical Director, Sports Medicine Rehabilitation. Dr. Portugal completed his residency at NYU Grossman and his fellowship at UMDNJ. He also received an MBA from Brandies in 2020. 

In this segment, Dr. Portugal indicated that in 2014, a systematic review was done, which found that a combination of PT and mobilization was strongly recommended, especially in patients in stages two and three. Cortisone injections were found to be most effective early, and acupuncture plus therapeutic exercises improved pain, range of motion and function. Therapeutic sonograph treatment was not recommended. PT is recommended after phase one or after the painful phase. A Cochrane study concluded that PT should be provided in combination with other treatments. Patients that were compliant with home exercises are shown to be equally effective compared to supervised stretching exercises. He also discussed cortical steroid injections compared to other interventions. Similarly, platelet-rich plasma (PRP) was described in comparison to other forms of treatment, such as physical therapy. A related area of interest is the use of shock wave therapy in comparison to oral steroids. Many patients do well with non-surgical forms of treatment, but surgery may be an option for those who do not do so well with non-surgical treatment.

Dr. Salvador Portugal is an Assistant Professor in the Dapartment of Rehabilitation Medicine at NYU Grossman School of Medicine. He is also Director of the Sports Fellowship program and Medical Director, Sports Medicine Rehabilitation. Dr. Portugal completed his residency at NYU Grossman and his fellowship at UMDNJ. He also received an MBA from Brandies in 2020. 

For this portion, he discussed several topics, such as clinical presentation, risk factors, pathophysiology, diagnostic testing, and non-surgical treatment options. He provided a review from the standpoint of what we should be doing in current practice. Shoulder injury usually is characterized as a marked decrease in range of motion. Patients often have difficulty reaching overhead or behind the back that causes a sensation of pain and stiffness. Prevalence in the general population is 2-5% and women are more affected than men. Pathophysiology is not often understood. Adhesive Capsulitis of the Shoulder after surgery potentially may be a risk. Prevalence is around 11% and women are affected more than men. He addressed the issue of which kind of imaging is important, such as X-rays and MRIs. He then moved on to additional diagnostic testing. Patients with a thyroid condition or diabetes are at increased risk of developing adhesive capsulitis. So, when should we begin considering testing or evaluating these conditions? Approximately one-third of patients with adhesive capsulitis are likely to have diabetes. Next, he focused on non-surgical forms of treatment and management.  

Dr. Moroz attended the NYU School of Medicine and remained at NYU-Rusk Rehabilitation for residency training, and subsequently, his first and only job. He rose through the faculty ranks and currently is Director of Residency Training and Vice Chair for Education. Dr. Moroz sought out additional training and became a New York State certified acupuncturist, and is directing the Integrative Sports Medicine program, which includes an 18-month track for PM&R residents leading them to becoming certified physician acupuncturists.

Dr. Brian Sunwoo is a current administrative chief resident in the Physical Medicine and Rehabilitation residency program at NYU Langone Health. He attended Rowan School of Osteopathic Medicine, where he received the Dean's Recognition Award and will begin a fellowship in Interventional Spine after completing residency. As an NYU resident, he has served on the Rusk Health Equity, GME Diversity and Inclusion, and House Staff Leadership Committees. Dr. Sunwoo currently is completing his clinical acupuncture certification through the NYU PM&R residency program with plans to incorporate its use in his future practice.  

The following items were discussed in Part 2: effectiveness of acupuncture treatment either pre- or post-operative in dealing with nausea and vomiting in the post-surgical period; use of acupuncture in treating mental health conditions; extent to which sham acupuncture is being used in research; whether expectancy data are collected beforehand to measure how strongly patients anticipate a positive acupuncture treatment outcome; health problems where research indicates a high-certainty level of evidence for acupuncture; use of artificial intelligence in acupuncture research and treatment; and current or planned research endeavors at NYU that involve acupuncture.

Dr. Moroz attended the NYU School of Medicine and remained at NYU-Rusk Rehabilitation for residency training, and subsequently, his first and only job. He rose through the faculty ranks and currently is Director of Residency Training and Vice Chair for Education. Dr. Moroz sought out additional training and became a New York State certified acupuncturist, and is directing the Integrative Sports Medicine program, which includes an 18-month track for PM&R residents leading them to becoming certified physician acupuncturists.

Dr. Brian Sunwoo is a current administrative chief resident in the Physical Medicine and Rehabilitation residency program at NYU Langone Health. He attended Rowan School of Osteopathic Medicine, where he received the Dean's Recognition Award and will begin a fellowship in Interventional Spine after completing residency. As an NYU resident, he has served on the Rusk Health Equity, GME Diversity and Inclusion, and House Staff Leadership Committees. Dr. Sunwoo currently is completing his clinical acupuncture certification through the NYU PM&R residency program with plans to incorporate its use in his future practice.  

The following items were discussed in Part 1: number of participants in the residency program at NYU using acupuncture with patients; professional qualifications deemed necessary to use acupuncture in treating patients; insurance company coverage of acupuncture treatment; role of patients’ age in achieving desired clinical outcomes involving acupuncture; different kinds of instruments used by acupuncture practitioners; acupuncture as a lone intervention and also as an adjunct to western medicine; contributions that acupuncture can make in dealing with problems, such as stroke; and possible differences among clinicians in different health professions regarding the effectiveness of acupuncture treatments?

Dr. Byron Schneider is currently an associate professor with the Department of Physical Medicine and Rehabilitation at Vanderbilt University Medical Center and serves as the Director of the Interventional Spine and Musculoskeletal Medicine Fellowship. Previously, he completed his residency and interventional spine fellowship at Stanford University. He has nearly 100 publications, with a research focus on the safety and outcomes of interventional spine procedures. He has given over 100 lectures at national and international meetings. He currently is on the Spine Intervention Society Board of Directors as the Chair of Research, and within the North American Spine Society is Chair of the Interventional Spine and Musculoskeletal Section as well as Co-Chair for the Coverage Committee.

In Part 2 of his presentation, he indicated that the study by Wolf and his group was observational and retrospective, so there are some missing data. They enrolled patients based on provocation discography, which you hope would result in better outcomes. He stated that this number, 50 percent of people saying that they are 50 percent better is very common in pain literature. He wouldn’t say it is favorable. Over and over, these are the numbers we see that turn out to be dead ends. These are non-compelling data unless we are able to show they are non-placebo. You need RCTs to do that. He is a huge proponent of observational studies. They can give you very meaningful clinical information, but unfortunately for a new technology like this, we need at least some evidence that these things are doing something beyond placebo. Next, he indicated the discussion in his presentation would shift to discussing some RCTs that have been published more recently. As of right now, however, the totality of evidence because of the negative RCTs in the research done today, stem cells do not work as a treatment for disc-related low back pain. He then described four new RCTs that came out in the last two years that will shed some new light. The first study involved a comparison with saline treatment. Unwanted side effects, such as infections and other complications have occurred as a result of the treatments in the four studies. Safety continues to be a concern in developing effective treatments using stem cell and PRP approaches.

Dr. Byron Schneider is currently an associate professor with the Department of Physical Medicine and Rehabilitation at Vanderbilt University Medical Center and serves as the Director of the Interventional Spine and Musculoskeletal Medicine Fellowship. Previously, he completed his residency and interventional spine fellowship at Stanford University. He has nearly 100 publications, with a research focus on the safety and outcomes of interventional spine procedures. He has given over 100 lectures at national and international meetings. He currently is on the Spine Intervention Society Board of Directors as the Chair of Research, and within the North American Spine Society is Chair of the Interventional Spine and Musculoskeletal Section as well as Co-Chair for the Coverage Committee.

In Part 1 of his presentation, the focus was on a systematic review that was done of how stem cells and PRP pertain to back pain. He began by going over the history and regulations. Traditionally as it pertains to all biologics, they were largely exempt from the pathway of the FDA. Because they did not go through that process, these medicines were allowed to be done, but really did not have any insurance coverage. They became a cash cow for those offering fee-for-service treatment for things that did not have a lot of evidence behind them yet. It led to much public confusion, but that gap has shrunk in recent years. The FDA began issuing more restrictive language in 2020 regarding treatments that were not approved by that agency. The primary purpose of the aforementioned review was to look at 50 or more percent relief of low back pain at a six-month outcome. Based on those criteria, the number of citations was whittled down from 3,000 citations reviewed to 37, then finally down to only 12 that actually met the criteria. Those results should be alarming given that hundreds of clinics in the U.S. were providing treatments for cash payments that were based on only 12 research papers. Only one paper was on PRPs and one on stem cell treatment. He then described a study on PRP in 2015. He also provided summaries of other investigations that entailed PRP and stem cell treatments.

Dr. Baumhauer is a tenured Professor and serves as the Senior Associate Dean of Academic Affairs for the University of Rochester School of Medicine and Dentistry. She also is the Associate Chair of Academic Affairs within the Department of Orthopaedics at the University of Rochester. In addition to providing clinical care and performing surgery, she holds the position as the Director of the Clinical Health Informatics Core for the UR Healthcare System and is a board of director of Accountable Health Partners, ACO for the Rochester Region. She received her Doctorate of Medicine from the University of Vermont College of Medicine. She completed orthopaedic residency at the Medical Center Hospital of Vermont and a Fellowship in Foot and Ankle Surgery at the Medical College of Wisconsin. She also completed a Masters in Public Health degree from the University of Rochester. Dr. Baumhauer is the past president of the American Board of Orthopaedic Surgery, American Orthopaedic Foot and Ankle Society (AOFAS), and Eastern Orthopaedic Association. She currently is the President of the Patient-Reported Outcomes Measurement Information System (PROMIS) Health Organization and has published over two hundred peer reviewed papers and book chapters.

In Part 2, Dr. Baumhauer described research showing that patients who were able to report at times that were important to the patient ended up visiting the emergency room less and were experiencing more favorable outcomes. She discussed how data are used. The first time seeing a patient, it is important to know what their baseline values are, e.g., mild depression and moderate symptoms for physical function and pain. Trends can be noted that make it possible before meeting with a patient to look at the PROMIS scores and be able to anticipate how much time to spend with this individual. It enables the physician to triage, which patients appreciate. Patients also are asked anchoring questions, such as general health status questions that make it possible to link the medical visit. An example is are you worse, better, or the same since your last visit? Another question is can you live with your symptoms? She also discussed how patients can ask questions, such as whether there will be substantial improvement as a result of surgery. If such an outcome is unlikely, surgery should not occur. Another question patients ask is which of various treatment options should be selected? It is important to know what the patient wants to measure.

Dr. Baumhauer is a tenured Professor and serves as the Senior Associate Dean of Academic Affairs for the University of Rochester School of Medicine and Dentistry. She also is the Associate Chair of Academic Affairs within the Department of Orthopaedics at the University of Rochester. In addition to providing clinical care and performing surgery, she holds the position as the Director of the Clinical Health Informatics Core for the UR Healthcare System and is a board of director of Accountable Health Partners, ACO for the Rochester Region. She received her Doctorate of Medicine from the University of Vermont College of Medicine. She completed orthopaedic residency at the Medical Center Hospital of Vermont and a Fellowship in Foot and Ankle Surgery at the Medical College of Wisconsin. She also completed a Masters in Public Health degree from the University of Rochester. Dr. Baumhauer is the past president of the American Board of Orthopaedic Surgery, American Orthopaedic Foot and Ankle Society (AOFAS), and Eastern Orthopaedic Association. She currently is the President of the Patient-Reported Outcomes Measurement Information System (PROMIS) Health Organization and has published over two hundred peer reviewed papers and book chapters.

Part 1:  Data are needed to help understand how a patient is feeling and functioning to implement preventive health strategies, maximize healthy behaviors, assess their treatment response, and understand how health care resources are being allocated. Dr. Baumhauer defined a patient reported outcome as information directly reported by the patient who experiences it and is not interpreted as when we usually obtain some health history and tell it in our terms and report it into the patient’s note. She provided examples of the disconnect between what is important to the patient and what the clinician believes is important for the patient. A validated number can be placed on how the patient is feeling and functioning. It is important that a validated instrument be used that is quick and does not hold up the clinician. At the University of Rochester, they landed on the use of PROMIS (Patient-Reported Outcomes Measurement Information System) on a custom platform called UR VOICE (Validated Outcomes in Clinical Experience). They collect the same information for each patient. They try to ask the right questions when the information is needed most. The aim is to be domain specific, such as symptom-based, using the core package of pain, physical function, and depression rather than focusing on various diseases. Depending on the medical specialty, the symptoms emphasized can be different. Compared to SF-36, PROMIS is a better measure since it is more responsive to change.

Dr. Kendall is a second-year resident physician at Rusk. She completed her undergraduate education in Nutrition Science with honors from Purdue University. Subsequently, she was awarded Master’s Student of the Year in 2017 by the Purdue University College of Health and Human Sciences for her graduate work in Cancer Epigenetics and Nutriepigenomics. Since discovering the field of physiatry as a medical student, she has adamantly pursued neurorehabilitation, spinal cord injury, and pain medicine research. She serves on the American Osteopathic College of Physical Medicine and Rehabilitation (AOCPMR) Resident Council, regularly provides mentorship to aspiring physiatrists, and serves on the Rusk Rehabilitation residency wellness committee. Her current rehabilitation interests include interventional spine medicine and movement disorders.   The following items were discussed in this one-part interview: incidence and prevalence data for amyotrophic lateral sclerosis (ALS) in the U.S.; the role of heredity; demographic groups more likely to experience the onset of this disease; preventability of ALS;, tools for making a clear diagnosis; ability to acquire wheelchairs in a timely fashion; when to initiate a custom power wheelchair order; training patients to use power wheelchairs; prevention of decubitus ulcers from sitting in an unchanged posture; and seeking to have an impact on legislation regarding this disease.

Originally from Brooklyn, Dr. Klyachman is the son of two Russian speaking immigrants and among the first in his family to pursue a career in medicine. He attended the University at Buffalo for his undergraduate education and continued his medical education at Touro College of Osteopathic Medicine in Harlem. After graduating, he went to Florida to complete an internship and currently is in the fourth year of a rehabilitation residency at NYU Rusk. He recently matched into a fellowship at NYU where he plans to continue specialty training that starts in July 2023. 

Dr. Lindsey Gurin is a clinical assistant professor of neurology, psychiatry, and rehabilitation medicine at NYU Langone Health. She is dual board-certified in neurology and psychiatry and currently serves as Director of Behavioral Neurology at NYU Langone Orthopedics Hospital, where she provides neuropsychiatric consultation to the Rusk acute inpatient brain injury rehabilitation service. She also is Director of the NYU Combined Psychiatry/Neurology Residency Training Program. Dr. Gurin has published on neuropsychiatric manifestations of brain injury and her current research interests include psychosis after brain injury; disorders of consciousness; and catatonia in patients with neurologic disorders.

Dr. Brian Im is heavily involved in program development and academic medicine. He has an active role in brain injury rehabilitation research at NYU. After completing medical school at SUNY Upstate Medical University, a rehabilitation residency at NYU School of Medicine/Rusk Rehabilitation, and a fellowship in brain injury medicine at UMDNJ/Johnson Rehabilitation Institute, his subsequent tenure at Bellevue Hospital focused upon an interest in improving brain injury rehabilitation for underserved populations.  He remains involved in this research at Bellevue Hospital while at his current role as the director for brain injury rehabilitation medicine at NYU/Rusk Rehabilitation. 

In Part One, the discussion included the following: a description of the care provided at NYU for patients who experience a brain injury from the perspective of the overall number and kinds of personnel involved and the clinical facilities in which they work; early neurorehabilitation and recovery from disorders of consciousness after severe COVID-19; and the kinds of challenges involved, such as arriving at a correct diagnosis of disorders of consciousness that could prove difficult because of a combination of patient and health system factors.

In Part Two, the discussion included the following: long COVID with brain fog and treatments that are being tried; a definition of the terms catatonia and hypoxia-ischemia and a description of their causes; challenges involved in diagnosing and treating catatonia effectively in a timely manner; possible outcome of ineffective treatment occurring if catatonia is under-recognized diagnostically, and current and future research endeavors at NYU pertaining to brain injury.

Dr. Lindsey Gurin is a clinical assistant professor of neurology, psychiatry, and rehabilitation medicine at NYU Langone Health. She is dual board-certified in neurology and psychiatry and currently serves as Director of Behavioral Neurology at NYU Langone Orthopedics Hospital, where she provides neuropsychiatric consultation to the Rusk acute inpatient brain injury rehabilitation service. She also is Director of the NYU Combined Psychiatry/Neurology Residency Training Program. Dr. Gurin has published on neuropsychiatric manifestations of brain injury and her current research interests include psychosis after brain injury; disorders of consciousness; and catatonia in patients with neurologic disorders.

Dr. Brian Im is heavily involved in program development and academic medicine. He has an active role in brain injury rehabilitation research at NYU. After completing medical school at SUNY Upstate Medical University, a rehabilitation residency at NYU School of Medicine/Rusk Rehabilitation, and a fellowship in brain injury medicine at UMDNJ/Johnson Rehabilitation Institute, his subsequent tenure at Bellevue Hospital focused upon an interest in improving brain injury rehabilitation for underserved populations.  He remains involved in this research at Bellevue Hospital while at his current role as the director for brain injury rehabilitation medicine at NYU/Rusk Rehabilitation. 

In Part One, the discussion included the following: a description of the care provided at NYU for patients who experience a brain injury from the perspective of the overall number and kinds of personnel involved and the clinical facilities in which they work; early neurorehabilitation and recovery from disorders of consciousness after severe COVID-19; and the kinds of challenges involved, such as arriving at a correct diagnosis of disorders of consciousness that could prove difficult because of a combination of patient and health system factors.

In Part Two, the discussion included the following: long COVID with brain fog and treatments that are being tried; a definition of the terms catatonia and hypoxia-ischemia and a description of their causes; challenges involved in diagnosing and treating catatonia effectively in a timely manner; possible outcome of ineffective treatment occurring if catatonia is under-recognized diagnostically, and current and future research endeavors at NYU pertaining to brain injury.

Part Two included a discussion of the barriers that students still face despite the ADA. They did not seek supportive accommodations because of stigma or fear. Dr. Rizzo wanted to draw attention to definitions of disability. He also emphasized that people with disabilities can help with accessibility and for coming up with empathetic dialogue that is critical in moving forward as a medical community. These agendas must be pushed here at NYU to ensure that we are doing enough to increase disability inclusion and also to ensure that patients are receiving the preventive medicine that they actually need. Dr. Wu indicated that in his research conducted 30 years ago, deans not only were asked how many medical school students have disabilities, but also “how did they do?” Did you do the right thing for society by producing good physicians at the end or did you pass along somebody who shouldn’t be there? The result was those students did as well and better than their able-bodied counterparts.

Part One of this grand round presentation delves into the struggle faced by individuals with disabilities and future directions to take to include them in the rehabilitation field. Both Drs. Rizzo and Wu have important stories to tell about living with a disability. An aim in this session is to understand the epidemiology of disability, the American with Disabilities Act (ADA), and be familiar with the barriers that individuals with disabilities face. According to new CDC data, the prevalence of disability in the non-institutionalized portion of the U.S. population is 26%. The data may understate the true prevalence. Data also were provided on the prevalence of disability among medical students, residents, and practicing physicians. These numbers also may under represent the true extent of disability among members of the medical community. A definition of disability in the American with Disabilities Act Amendments and its implications were discussed.

Veronica Alfaro is a senior Design Technologist on the NYU Population Health Research team. Her work occurs in the intersection between accessibility and health care through the fields of human-centered design, user experience, user interface design, and information visualization. Her most recent focus is on reimagining health care and the use of technology and design to improve the relationship between patients and health care providers in the FuturePractice| HiBRID lab. Additionally, she focuses on the design of frameworks for developing customizable assistive technologies for individuals with disabilities, which she developed as part of her residency in the NYU Ability Project. She has an MPS degree from NYU’s Interactive Telecommunications Program.

In Part 2, the following items were discussed: collaboration with entities within and outside of NYU; how design thinking and innovative strategies are influenced by members of specific clinical groups; taking into account during the design process that patients who experience diminishing capacities may have to abandon digital health technologies; possible unintended negative consequences relating to novel digital technologies; challenges involved in the adoption of new technologies; and launching new research endeavors.

Veronica Alfaro is a senior Design Technologist on the NYU Population Health Research team. Her work occurs in the intersection between accessibility and health care through the fields of human-centered design, user experience, user interface design, and information visualization. Her most recent focus is on reimagining health care and the use of technology and design to improve the relationship between patients and health care providers in the FuturePractice| HiBRID lab. Additionally, she focuses on the design of frameworks for developing customizable assistive technologies for individuals with disabilities, which she developed as part of her residency in the NYU Ability Project. She has an MPS degree from NYU’s Interactive Telecommunications Program.

In Part 1, the following items were discussed: how she became interested in designing assistive technologies; use of 3D printing in producing custom educational materials and medical devices; her role in the the FuturePractice/HiBRID team;  and how the digital health component is integrated into the various FuturePractice/HiBRID activities.

Professor Arthur Matthews is chief operating officer of Matthews & Matthews Consulting, a boutique firm specializing in customized and divergent aspects of human resources, labor, and the workforce. His clients primarily are corporations, government agencies, unions, and 501(C)(3) organizations that include Johns Hopkins University, Con Edison, the Centers for Disease Control and Prevention, and New York City Health and Hospitals. Additionally, he is a Teaching Professor of Labor and Employment Relations at Penn State University and a Visiting Lecturer at the University of Arkansas. He began his teaching career in 1987 first at the Medgar Evers College/City University of New York and the Van Arsdale School of Labor Studies. Since 1989 he also has served on the faculty at NYU and Cornell University School of Industrial and Labor Relations. His law degree with a Concentration in Human Rights, Civil Rights, and Public Policy is from Howard University. 

In this interview, he discusses the following: principles of leadership, going from a leader to becoming an ambassador, interchangeable skills for different situations, dealing with conflict, adding leadership training to the curricula at health professions schools, and the notion of shared leadership.

Dr. Linda Carozza is a clinical professor in the Department of Physical Medicine and Rehabilitation at NYU Langone Health. She has written extensively on the broad topic of communication and aging with a focus on creative approaches to improving the quality of life. Her publications include the topic of counselling in chronic aphasia: integrating theory with professional roles in clinical practice and also on the topic of non-pharmacological approaches to dementia. She has a Certificate of Clinical Competence from the American Speech-Language-Hearing Association. In 2021, she was selected a National Academy of Practice Speech Pathology Fellow. She has a doctorate in speech and hearing sciences from the Graduate Center at the City University of New York. Her baccalaureate and master’s degree in speech and hearing are from the City College of New York. 

Topics discussed in Part 2  included the following: common symptoms that will be experienced by an individual who is beginning to reveal signs of dementia or Alzheimer’s disease; primary progressive aphasia (PPA); effective tools and resources used since 2019 when the World Health Organization published its first evidence-based guidelines on dementia risk reduction; roles played by informal and family caregivers and preparing them to do so; use of telehealth in treating patients; non-pharmacological approaches in assessment and treatment of dementia; and future research projects envisioned.

Dr. Linda Carozza is a clinical professor in the Department of Physical Medicine and Rehabilitation at NYU Langone Health. She has written extensively on the broad topic of communication and aging with a focus on creative approaches to improving the quality of life. Her publications include the topic of counselling in chronic aphasia: integrating theory with professional roles in clinical practice and also on the topic of non-pharmacological approaches to dementia. She has a Certificate of Clinical Competence from the American Speech-Language-Hearing Association. In 2021, she was selected a National Academy of Practice Speech Pathology Fellow. She has a doctorate in speech and hearing sciences from the Graduate Center at the City University of New York. Her baccalaureate and master’s degree in speech and hearing are from the City College of New York. 

Part 1 included a discussion of the following: how she become interested in the area of adult neurogenic communication disorders; conditions encompassed by the term adult neurogenic communication disorders; professional qualifications for students or other individuals who wish to pursue this line of practice; some defining characteristics of dementia-communication changes and how they differ from stroke-treated communication changes; incidence and prevalence of dementia and Alzheimer’s disease in the US; whether the terms dementia and Alzheimer’s disease basically are the same, and if not,  important distinctions between them; and some major causes of dementia.

Dr. Koto Ishida is an Associate Professor in the Department of Neurology at NYU Grossman School of Medicine. She also serves as Medical Director of the Stroke Program at NYU Langone Health and Director of Clinical Affairs at the Center for Stroke and Neurovascular Diseases. She is Board-certified both in vascular neurology and neurology by the American Board of Psychiatry & Neurology. Her medical degree is from the University of Rochester. She completed her residency in neurology at the Hospital of the University of Pennsylvania where she had a fellowship in vascular neurology. Dr. Ishida has her name on 70 publications in the professional literature.    

The following topics were discussed in Part 3: Patient-Reported Outcome Measures employed in vascular technology at NYU and their utility; the extent to which patients who  experienced a stroke are suitable candidates for becoming competent self-managers so that they can be effective in self-monitoring, recognizing and reporting symptoms, and treating side effects, and efforts undertaken at NYU to foster self-management by patients; if patients are treated at a presenting hospital, whether teleneurology is involved in providing care; and assessing the value of self-wearable devices for diagnostic purposes and their future prospects for achieving better health care outcomes?

Dr. Koto Ishida is an Associate Professor in the Department of Neurology at NYU Grossman School of Medicine. She also serves as Medical Director of the Stroke Program at NYU Langone Health and Director of Clinical Affairs at the Center for Stroke and Neurovascular Diseases. She is Board-certified both in vascular neurology and neurology by the American Board of Psychiatry & Neurology. Her medical degree is from the University of Rochester. She completed her residency in neurology at the Hospital of the University of Pennsylvania where she had a fellowship in vascular neurology. Dr. Ishida has her name on 70 publications in the professional literature.    

The following topics were discussed in Part 2: once patients arrive at NYU Langone Health emergency rooms and a stroke is confirmed, the steps in treatment that will follow; after stroke treatments are provided, how prognostication is affected by the interplay between demographic factors, such as age, sex, and ethnicity, the kind of stroke, stroke causation, and clinical severity; the role, if any, that blood biomarkers play in improving the prognostic assessment; how a patient’s cognition is affected by having a stroke, the degree to which factors such as pre- and post-stroke physical fitness, smoking, and body weight play a role; and the kind of impact that related mental states, such as depression and anxiety can have on cognition.

Dr. Koto Ishida is an Associate Professor in the Department of Neurology at NYU Grossman School of Medicine. She also serves as Medical Director of the Stroke Program at NYU Langone Health and Director of Clinical Affairs at the Center for Stroke and Neurovascular Diseases. She is Board-certified both in vascular neurology and neurology by the American Board of Psychiatry & Neurology. Her medical degree is from the University of Rochester. She completed her residency in neurology at the Hospital of the University of Pennsylvania where she had a fellowship in vascular neurology. Dr. Ishida has her name on 70 publications in the professional literature.    

This is a special three-part series.

Douglas H. Smith, MD, is the Robert A. Groff Endowed Professor Neurosurgery and Director of the Center for Brain Injury and Repair at the University of Pennsylvania. He is the Scientific Director of the Big 10/Ivy League Collaboration on Concussion and also serves as a member on the Scientific Advisory Boards of the US National Football League (NFL), the National Collegiate Athletic Association (NCAA)-DoD consortium on concussion, and the International Concussion Society. 

This is the second part of a two-part series. In this one, he points out that:

We find that when we are looking at over time the changes of profiles, it means they are appearing and disappearing. How does that look like compared to the appearance of those proteins in the blood?  We are finding an interesting correlation that is kind of a combination between how open the blood brain barrier is and how much axon pathology is. It has become possible to diagnose the 20 percent of patients who will have persistent symptoms at the time they come to the ED and then we can direct them to you in rehabilitation. The next step is to have a clinical trial. He asked how all this links with neurodegeneration? Within hours of an injury, it can begin to look like an Alzheimer’s disease brain. Something is going on that is crazy. An axon injury is one that can keep on taking. Tau is what gets all the big news. It may be too simplistic a view. It is not just tau. It actually is a whole bunch of things happening to the brain. Many other different types of neuropathologies occur in the brain that are initiated by injury. A subset of patients will develop these changes. If males dominate concussions, which they do, in theory you would think that they possibly would dominate dementia or mild cognitive impairment later in life, but that is not true. Women have a higher rate. There is a lot of work to be done. A lot of people who have concussions are going to be fine and we need to find a way to avoid having people worry and cause stress. A Question and Answer period followed  the presentation.

Douglas H. Smith, MD, is the Robert A. Groff Endowed Professor Neurosurgery and Director of the Center for Brain Injury and Repair at the University of Pennsylvania. He is the Scientific Director of the Big 10/Ivy League Collaboration on Concussion and also serves as a member on the Scientific Advisory Boards of the US National Football League (NFL), the National Collegiate Athletic Association (NCAA)-DoD consortium on concussion, and the International Concussion Society. 

This is the first of a two-part series. In this one, he points out that: 

An objective is to look at the biomechanics of concussion and how that selectively induces injuries to axons, and how to detect it non-invasively. Also, how does that time zero, when the injury occurs, cause neurodegeneration later on? It is weird that the definition of a concussion does not include what is going on in the brain, which is an actual true definition of a diagnosis. He showed different pathologies in concussion. White matter in the brain in particular seems vulnerable to the forces of a concussion. He discussed the role of axons in a brain injury, noting that Tau is our selective marker for axons. He talked about how multiple swelling occurs along the axon. Think of the brain being a kind of eavesdropping system, a shadow network.  He indicated that in a sports injury in soccer, there is a higher rate of concussion and a worse outcome for women. Male axons are bigger and have a more complex microtubular array. On average, smaller axons are more vulnerable and subject to greater dysfunction and loss of synchrony, so normal functions of networks are impaired in females compared to males. Another change that does a lot in a concussion is disruption of the blood brain barrier. Think of a blood brain barrier disruption map as where we see the distribution of axonal pathology. 

Dr. Karsten has more than five years of clinical experience across diverse healthcare settings and currently works full-time on an acute inpatient neurorehabilitation unit, evaluating and treating adults with acquired brain injury and other neurological & complex orthopedic conditions. She also serves as a mentor to other staff members and acts as a supporting faculty member of the Neurologic Residency Program in acute inpatient rehabilitation at NYU Langone Orthopedic Hospital. Dr. Karsten has presented posters at American Physical Therapy Association meetings and also at the 5th International Gait and Balance Symposium in Multiple Sclerosis. Her Doctor of Physical Therapy degree is from Hunter College and she has achieved Board Certification in Neurologic Physical Therapy.

Part 2 covers related topics, including: some challenges that may characterize treating different kinds of patients based on age; possible impairments associated with an ABI involving  communication, loss of mobility, increased fatigue, sleep difficulties, and vision deficits; patients’ level of self-awareness; negative health behaviors exhibited prior to sustaining a brain injury; and challenges faced by caregivers.  

Dr. Karsten has more than five years of clinical experience across diverse healthcare settings and currently works full-time on an acute inpatient neurorehabilitation unit, evaluating and treating adults with acquired brain injury and other neurological & complex orthopedic conditions. She also serves as a mentor to other staff members and acts as a supporting faculty member of the Neurologic Residency Program in acute inpatient rehabilitation at NYU Langone Orthopedic Hospital. Dr. Karsten has presented posters at American Physical Therapy Association meetings and also at the 5th International Gait and Balance Symposium in Multiple Sclerosis. Her Doctor of Physical Therapy degree is from Hunter College and she has achieved Board Certification in Neurologic Physical Therapy.

Part 1 covers various topics, including: an average day’s caseload size of patients who are being treated for an acquired brain injury or ABI; creation of a tool called the Preparedness for Caregiving Scale; kinds of skills being developed by caregivers; members of the rehabilitation team participating in caregiver training;  Care Partner Carryover Day activities; and program limitations. 

Dr. Jonas Sokolof graduated from the New York College of Osteopathic Medicine. He completed his PM&R residency at Harvard Medical School and his fellowship at the Kessler Institute. He joined NYU Langone Health and the Rusk Rehabilitation Institute in 2018 where he has served as director of oncological rehabilitation. His research interests include the role of lifestyle intervention in the rehabilitation of cancer patients. 

Dr. Sokolof noted in Part 2 of his presentation that many patients may be reluctant to take medications. They don’t want injections and the last thing they look forward to is taking another drug or having something else done to them. Trismus is condition we often see in this population, developing from radiation. We tend to see it more as actual fibrosis of the muscles of mastication. Neuropathy also is quite common in this population. We often see it from the radiation itself. Post-radiation functional status and quality of life have a strong correlation with overall long-term survival in the head and neck cancer population. As physiatrists, not only do we have a role to play in restoring functioning, we are involved in altering the disease course itself. The fibrosis syndrome stemming from radiation is problematic and progressive. There is nothing out there so far that can cure it. An exciting emerging treatment in a study he is involved in at NYU is looking at photo biomodulation therapy or low-level laser light therapy. It is a technology used a lot in sports medicine to treat musculoskeletal pain and sports-related injuries. It basically is light therapy rather than heat therapy and works at the level of the mitochondria. The primary objective is to determine if this is a feasible treatment for head and neck cancer patients. He concluded by indicating that the earlier we can become involved in the whole cancer continuum as physiatrists the better, especially in radiation fibrosis. A question-and-answer question followed his presentation.

Dr. Jonas Sokolof graduated from the New York College of Osteopathic Medicine. He completed his PM&R residency at Harvard Medical School and his fellowship at the Kessler Institute. He joined NYU Langone Health and the Rusk Rehabilitation Institute in 2018 where he has served as director of oncological rehabilitation. His research interests include the role of lifestyle intervention in the rehabilitation of cancer patients. 

In Part 1 of his presentation, he indicated that head and neck cancer is a unique pathology where a huge impact is made by physiatry. This kind of cancer is more commonly associated with older males, alcohol and tobacco use, genetics, and other factors. Head and neck cancer is on the rise in younger males. He mentioned different cancer subtypes, such as oral cavity and lip. Induction chemotherapy and chemoradiation tend to be the main forms of treatment presently rather than surgery alone. Radiation affects the surrounding tissue, which is where we as physiatrists come into play. The more common conditions encountered include pain, dysphagia, inability to open the mouth, and limited head and neck mobility. As physiatrists, there are conditions that we ourselves proactively can treat as opposed to speech and swallowing dysfunctions that we refer to other clinicians. Fibrosis can extend throughout the entire radiation field, affecting all the skin, nerves, muscles, and blood vessels. Radiation tends to disrupt the normal phases of healing. He described various effects that are irreversible. Patients usually are referred to physiatrists at the first sign of lymphedema. He stated that a high suicide rate is associated with this kind of cancer. Physiatry care should be involved in every stage of treatment. He carries over a sports medicine approach to oncological rehabilitation with the first step in the process being pain control followed by range of motion and strength and endurance. He also described some interventions for treating lymphedema.

Welcome back to this special two-part series.

Part 1 covered various topics, including:  pulmonary conditions that could lead to the need for a transplant; if the recent resurgence of the coronavirus and its continued display of new emerging variants has affected the ability to furnish care for patients; kinds of contributions physiatry, physical therapy, occupational therapy, and speech-language pathology clinicians can make in preparing patients for transplantation and in optimizing function; whether rehabilitation settings differ based on the kinds of health problems that patients have; and prevention of the occurrence of hospital readmissions. 

Part 2 covers many new areas, including: how patients requiring rehabilitation services may differ according to personal characteristics, such as age and how such differences are taken into account when providing treatment; kinds of physiological changes patients can experience post-transplantation; prevention of the risk of infection; steps taken to deal with the issue of nonadherence of recommended treatment protocols; use of rehabilitation notebooks and peer support groups; comparison of telehealth and face-to-face interactions with patients; and kinds of key rehabilitation questions to address.

Megan Carroll is a Board Certified Clinical Specialist in Geriatric physical therapy. She has been an intensive care unit physical therapist working at NYU Langone Health since 2015.

Camille Magsombol works on developing occupational therapy programs to support patients' successful health management of their chronic diseases, including medication management.

Christina Moriarty's work focuses on speech/swallow assessment and treatment with head and neck cancer as well patients in the surgical intensive care unit, including those with heart and lung transplants. 

Sofia Prilik is a physiatrist who serves as clinical director of inpatient cardiac and pulmonary rehabilitation, with a focus on inpatient rehabilitation of lung and heart transplant patients.

Welcome to this special two-part series with a panel of speakers.  Part 1 covers various topics, including:  pulmonary conditions that could lead to the need for a transplant; if the recent resurgence of the coronavirus and its continued display of new emerging variants has affected the ability to furnish care for patients; kinds of contributions physiatry, physical therapy, occupational therapy, and speech-language pathology clinicians can make in preparing patients for transplantation and in optimizing function; whether rehabilitation settings differ based on the kinds of health problems that patients have; and prevention of the occurrence of hospital readmissions. 

Megan Carroll is a Board Certified Clinical Specialist in Geriatric physical therapy. She has been an intensive care unit physical therapist working at NYU Langone Health since 2015.

Camille Magsombol works on developing occupational therapy programs to support patients' successful health management of their chronic diseases, including medication management.

Christina Moriarty's work focuses on speech/swallow assessment and treatment with head and neck cancer as well patients in the surgical intensive care unit, including those with heart and lung transplants. 

Sofia Prilik is a physiatrist who serves as clinical director of inpatient cardiac and pulmonary rehabilitation, with a focus on inpatient rehabilitation of lung and heart transplant patients.

In Part 1, we discussed the incidence and prevalence of MS in the United States; whether MS is on the rise, holding steady, or in decline; kinds of symptoms that occur either singly or in combination and their impact on patients from the perspective of psychology; roles that stress and mood disturbances play in influencing various MS symptoms; how perception of illness perception by patients has an impact on psychological distress; other kinds of therapeutic interventions to treat symptoms; cultivation of resilience among patients; and helping patients to become adept as self-managers of MS.

In Part 2, we discussed the use of cannabis for medicinal purposes among patients with MS; non-adherence to prescribed treatment plans; the extent to which lockdown policies have disrupted normal lifestyle and the ability to access health services; use of telemedicine with patients and how it compares in effectiveness with face-to-face interactions; and key insights observed as a result of working with  patients. 

Felicia Connor is the Director of Internship and Training for an APA approved internship program at NYU Langone Health, Rusk Rehabilitation. She is Board Certified in Rehabilitation Psychology and is a licensed clinical psychologist in Delaware and New York. For the last decade, she has specialized in rehabilitation of individuals with medical and neurological conditions with Traumatic Brain Injury, concussion, stroke and multiple sclerosis. She administers neuropsychological assessment and provides cognitive remediation and individual and group psychotherapy for individuals who are adjusting to their medical conditions. 

Barbara Cicero is the Program Manager of the Adult Outpatient Psychology Service at NYU Langone Health, Rusk Rehabilitation. She received her Ph.D. from the Graduate Center of CUNY and completed a post-doctoral fellowship in Rehabilitation Psychology at Mount Sinai Medical Center. In addition to her administrative responsibilities, she conducts neuropsychological evaluations and provides individual and group treatment to individuals with a variety of medical and neurological conditions. Her clinical interests include the assessment and treatment of individuals with traumatic brain injury and multiple sclerosis. 

In Part 1, we discussed the incidence and prevalence of MS in the United States; whether MS is on the rise, holding steady, or in decline; kinds of symptoms that occur either singly or in combination and their impact on patients from the perspective of psychology; roles that stress and mood disturbances play in influencing various MS symptoms; how perception of illness perception by patients has an impact on psychological distress; other kinds of therapeutic interventions to treat symptoms; cultivation of resilience among patients; and helping patients to become adept as self-managers of MS.

Felicia Connor is the Director of Internship and Training for an APA approved internship program at NYU Langone Health, Rusk Rehabilitation. She is Board Certified in Rehabilitation Psychology and is a licensed clinical psychologist in Delaware and New York. For the last decade, she has specialized in rehabilitation of individuals with medical and neurological conditions with Traumatic Brain Injury, concussion, stroke and multiple sclerosis. She administers neuropsychological assessment and provides cognitive remediation and individual and group psychotherapy for individuals who are adjusting to their medical conditions.

Barbara Cicero is the Program Manager of the Adult Outpatient Psychology Service at NYU Langone Health, Rusk Rehabilitation. She received her Ph.D. from the Graduate Center of CUNY and completed a post-doctoral fellowship in Rehabilitation Psychology at Mount Sinai Medical Center. In addition to her administrative responsibilities, she conducts neuropsychological evaluations and provides individual and group treatment to individuals with a variety of medical and neurological conditions. Her clinical interests include the assessment and treatment of individuals with traumatic brain injury and multiple sclerosis. 

Dr. Aaron Johnson is a researcher and speech-language pathologist specializing in voice debilitation and rehabilitation. His research laboratory is funded by the National Institutes of Health. He uses novel translational research methods to examine the effects of vocal training on laryngeal neuromuscular mechanisms in the aging larynx. His professional background includes a decade-long experience serving as a classical singer and teacher of singing.

Dr. Johnson began Part 2 of his presentation regarding how the idea of exercise is to have some sort of repeated muscle use or stress designed to induce specific adaptations. The goals are to increase the strength or endurance of the muscles. Vocal exercises are built on both sides of the continuum. Endurance training involves a long duration of this activity under low load with high repetitions so we can have a power output over longer periods of time. With resistance training, we are thinking of short durations of activity with high load and typically not many repetitions. Resistance training with the voice is trickier to apply. He referred to his work at the University of Wisconsin prior to arriving at NYU. He discussed the advantages of using a rat model based on ultrasonic vocalizations. Rats produce these by using the same underlying laryngeal neuromuscular mechanisms that we use to produce our vocalizations as humans. He showed a video of how rats are trained and discussed some findings of research that was undertaken, showing how louder vocalizations were achieved. Another study included younger rats and changes in muscle fiber type composition.  

Dr. Aaron Johnson is a researcher and speech-language pathologist specializing in voice debilitation and rehabilitation. His research laboratory is funded by the National Institutes of Health. He uses novel translational research methods to examine the effects of vocal training on laryngeal neuromuscular mechanisms in the aging larynx. His professional background includes a decade-long experience serving as a classical singer and teacher of singing.

In Part 1 of his presentation, Dr. Johnson reviewed typical changes in the voice that relate to aging. His research group does MRI work and imaging studies in both humans and rodents. An increase in the number of older adults has helped to shift research into how to improve the quality of life among this group. He likes the following definition of aging: "It is a time-independent series of cumulative, progressive, intrinsic, and deleterious functional and structural changes that usually begin to manifest themselves in reproductive maturity and eventually culminate in death." A hallmark of aging is individual variability. Changes due to aging are intrinsic and should be considered independently from external factors such as disease. The sound of our voice changes in pitch and vocal quality as we grow older. He compared the voice of actress Katherine Hepburn on two occasions separated by 50 years, involving factors, such as speech rate and articulation. He discussed the underlying physiology of voice production. With age, the primary effect on the vocal tract is muscle atrophy, which in relation to aging is called sarcopenia. He discussed the respiratory system. The primary change that influences voice is calcification of the costal cartilages and weakening of respiratory muscles, which leads to decreased respiratory capacity. A big cause of an increased effort to get the voice to work is what happens at the level of the larynx.

Dr. Rizzo currently serves as director of innovation and technology in the department of rehabilitation medicine. He has published extensively. His research topics include: biomechanics; assistive and wearable technology; blindness and visual impairment; and sensory augmentation. He is a graduate of New York Medical College and completed his residency in physical medicine and rehabilitation at NYU as well as a clinical research fellowship at the Rusk Rehabilitation Institute. 

Dr. Rizzo began Part 2 of his grand round presentations with the question, “OK, what were our findings?” With existing GPS data sets, we need to be mindful of side view versus front view in where cameras are positioned. A data set being described had more side view images than front view, which can be extremely important for the visually impaired. He pointed to being excited  about a collaboration with the United Nations. We have shared these data with that organization and they are quite impressed with our results, which can be of potential use to blind individuals navigating the UN building. We are creating a cellphone application that uses vision in place recognition. The UN is providing some funding support for a master’s student working on this project. Dr. Rizzothen responded to a question regarding falls and whether there is information to assess the relative slipperiness of surfaces. Ground surfaces are attracting more attention, such as puddles and how to reroute pedestrians around hazardous terrain. He then described a reconstruction project that is underway to change different environments by developing new approaches to navigating subway stations consisting of multiple floors and tracks. He played a video clip that shows how reconstruction is occurring. He addressed the question of how we handle all this video data for these mobility platforms and what a technician must do with all this high-resolution video data arriving. He also indicated that we currently are looking at sending the data and having new transmission policies, and also work being accomplished on dual connectivity. A question-and-answer period followed his presentation.

John-Ross (JR) Rizzo, MD is a physician scientist at Rusk Rehabilitation. He leads the Visuomotor Integration Laboratory where his team focuses on eye-hand coordination as it relates to acquired brain injury. Dr. Rizzo has been recognized as a Top 40 under 40 by Crain’s for his industry-leading innovation and dedication to transforming the lives of those with vision deficiencies worldwide. 

Dr. Rizzo began Part 1 of a two-part grand rounds presentation by asking, “What if the lights suddenly went out in this room?” He then proceeded to discuss virtual reality demonstrations of the three biggest vision killers in the U.S.: age-related macular degeneration, glaucoma, and diabetic retinopathy. He showed a filter and asked the audience how disturbing it would be if you had it constantly sitting on top of your visual perception?  He displayed views to demonstrate profound differences between clear visual perception and altered perception secondary to these conditions. The problem is going from bad to worse. In the U.S., there are 27 million adults ages 18 and older who report vision loss, and by 2050, the number can be expected to approach 52 million. Impaired vision can affect mobility and lead to many problems, such as massive unemployment rates, quality of life losses, and functional dependencies. He then described current mobility solutions, such as primary mobility tools. A worry is that the standard of care can lead to an immobility downward spiral. So as a consequence, obesity, stroke, and diabetes among other problems such as falls all jump upward. He provided a description of many devices being developed to deal with vision loss. The differences between the spatial world of the blind and the sighted were illustrated. Dr. Rizzo described a lengthy itemization of impediments to navigation on city sidewalks that visually impaired individuals must attempt to deal with successfully.

Dr. Antonio Stecco is an Assistant Professor at Rusk Rehabilitation, New York University. A physiatrist, he has been President of the Fascial Manipulation Association since 2010, Assistant to the President of the International Society of Physical Medicine and Rehabilitation from 2012 to 2014, and President of the International Myopain Society since 2020. His scientific activity is devoted to the study of the human fasciae from a macroscopically, histologically and patho-physiologically point of view. He personally made over 100 cadaver dissections for research. From 2007, he organized and personally held theoretical-practical courses about the Fascial Manipulation method in all five continents. The author of more than 50 in extensor papers about the fascia, Dr. Stecco has co-authored 5 books and is co-author of different chapters of international books. His medical degree and PhD degree are from the University of Padova in Italy.

In Part 1, we discussed: what attracted him to accept a position at NYU Langone Health; whether the COVID resurgence affected his ability to do research and furnish care for patients; results of his research on a comparison between traditional rehabilitation treatment and fascial manipulation of chronic neck pain; the results of a study he conducted on the role played by fasciae in ankle injuries sustained by basketball players; differences between males and females in the kind of injuries they sustain to their ankles and other body parts playing basketball; his training of major league baseball players in using fascial manipulation to decrease injury and improve performance; how to decrease injury among soccer players; and how fascial or muscle stretching exercises are an integral part of rehabilitation and athletics. 

In Part 2, we discussed: why determining the underlying cause of elbow pain can prove to be difficult; what new developments have occurred since he co-authored an article on the topic of treatment options for fascial disorders; apart from treatment modalities he described, how other interventions such as surgery, medications, and physical therapy are applied; patients' use of complementary, alternative, and integrative forms of treatment; his use of telemedicine in the treatment of patients; the time lag between when medical innovations occur and their widespread adoption; and current studies in which he is involved or expects to undertake with his NYU colleagues

Dr. Antonio Stecco is an Assistant Professor at Rusk Rehabilitation, New York University. A physiatrist, he has been President of the Fascial Manipulation Association since 2010, Assistant to the President of the International Society of Physical Medicine and Rehabilitation from 2012 to 2014, and President of the International Myopain Society since 2020. His scientific activity is devoted to the study of the human fasciae from a macroscopically, histologically and patho-physiologically point of view. He personally made over 100 cadaver dissections for research. From 2007, he organized and personally held theoretical-practical courses about the Fascial Manipulation method in all five continents. The author of more than 50 in extensor papers about the fascia, Dr. Stecco has co-authored 5 books and is co-author of different chapters of international books. His medical degree and PhD degree are from the University of Padova in Italy.

In Part 1, we discussed: what attracted him to accept a position at NYU Langone Health; whether the COVID resurgence affected his ability to do research and furnish care for patients; results of his research on a comparison between traditional rehabilitation treatment and fascial manipulation of chronic neck pain; the results of a study he conducted on the role played by fasciae in ankle injuries sustained by basketball players; differences between males and females in the kind of injuries they sustain to their ankles and other body parts playing basketball; his training of major league baseball players in using fascial manipulation to decrease injury and improve performance; how to decrease injury among soccer players; and how fascial or muscle stretching exercises are an integral part of rehabilitation and athletics.  

Part 2

Advance care planning involves talking now about the future and the setting where someone has deteriorating health and is not able to converse with clinicians about patients’ wishes, preferences, fears, expectations of what is going on, and their hopes. At this juncture, there can be a discussion about a patient’s quality of life and what he or she would like it to be. Sometimes, patient preferences can be put into advance directives (e.g., a living will or a medical power-of-attorney). Some barriers to advance care planning were described. Examples of patient barriers are procrastination, apathy, and fear of burdening the family. Some provider barriers are a lack of desire in talking about a negative future outcome and not wanting to burden patients and families by discussing this topic. Two other big considerations are time constraints on the part of providers and a general lack of knowledge about advance directives. It is important to be able to offer some sort of direction to families regarding possible health care outcomes even when there is a lot of uncertainty. End-of-life care can make some individuals nervous, which is understandable. Withholding or withdrawing interventions that are not in line with patient goals is OK. We do not want to cause any harm or do inappropriate things. As long as we are eliciting what is important to families and doing what meets their goals, generally speaking, we are doing the right thing. 

Part 1

Although cancer is the second lead cause of death in the U.S., the rate has been falling. It is becoming more of a chronic disease and has a treatment paradigm that is different from the past. Cancer also is the second most common cause of disability claims. Breast and prostate cancer have a heightened incidence of disabling complications, which is relevant because it is a potential interplay area of palliative care and rehabilitation. Fewer patients are dying in hospitals while the home and hospice settings are on a little upswing. He mentioned common symptoms (e.g., pain and shortness of breath) at end-of-life that differentiate patients with cancer from those who do not have it. The ultimate goal of palliative care and rehabilitation is to improve quality of life. Palliative medicine is one component of the bigger group of palliative care interventions. Regarding hospice care, someone may or may not be eligible for hospice services because of the insurance situation, but everybody is eligible for good end-of-life care and that is what can be provided regardless of insurance status. He then discussed what rehabilitation entails. One main focus is pain management. He indicated ways in which rehabilitation and palliative care can be provided together effectively in four domains, e.g., caregiver support.

Dr. Jonas Sokolof is Director of the Division of Oncological Rehabilitation and Clinical Associate Professor in the Department of Rehabilitation Medicine at NYU Grossman School of Medicine. He is certified by the American Board of PM&R both in Sports Medicine and in Physical Medicine & Rehabilitation. His doctor of osteopathy degree is from the New York Institute Of Technology. His Residency occurred at the Harvard Medical School and the Spaulding Rehabilitation Hospital in Boston. He also had a fellowship in sports medicine from Rutgers New Jersey Medical School. Prior to arriving at NYU Langone Health in 2018, he was at the Memorial Sloan Kettering Cancer Center in New York City.

Dr. Jonas Sokolof is Director of the Division of Oncological Rehabilitation and Clinical Associate Professor in the Department of Rehabilitation Medicine at NYU Grossman School of Medicine. He is certified by the American Board of PM&R both in Sports Medicine and in Physical Medicine & Rehabilitation. His doctor of osteopathy degree is from the New York Institute Of Technology. His Residency occurred at the Harvard Medical School and the Spaulding Rehabilitation Hospital in Boston. He also had a fellowship in sports medicine from Rutgers New Jersey Medical School. Prior to arriving at NYU Langone Health in 2018, he was at the Memorial Sloan Kettering Cancer Center in New York City.

PART TWO

In Part 1, Dr. Kim presented information about the historical and legal background for cannabis, variations in policies in the states, and the status of current research. In Part 2, she discussed cancer pain that is not neuropathic. She described the results of a study that involved opioid refractory cancer pain. Evidence currently shows that patients who have increased access to cannabis actually have higher rates of opioid overdose and deaths. She reviewed a case of one of her patients who had prostate cancer. This individual was not amenable to physical therapy and was weaned off opioids because they were not effective. Finally, they decided to try different types of cannabis for pain and sleep and he is doing quite well. He eventually used a combination of low and high THC capsules and was weaned off all other drugs. She and her colleagues also looked at how patients considered the use of cannabinoid therapy and found that overall they preferred it for their future chemo. Even though cannabis is a natural product, it is not true that it is free of side effects. There is some concern that it can have interactions on the heart, result in psychotic symptoms, affect psychomotor performance, and lead to an increase in tolerance, making it necessary to use higher and higher doses to achieve the same effect. A question-and-answer period followed her presentation. 

PART ONE

In Part 1 of a two-segment presentation, Dr. Kim discussed historical and legal background for medical cannabis and cannabis in general; mechanism of action; applications for pain and symptom management; the science behind cannabis for cancer care; relative safety issues; contraindications and monitoring; and some public health concerns. She defined cannabis, marijuana, hemp, and indicated various code names for recreational marijuana. Marijuana was criminalized and removed from the U.S. Pharmacopeia in 1941, Most recently, some states have legalized it both medically and recreationally. For medical purposes, there is a lot of variation in what states will allow. A concern has been about the presence of contaminants in many products. Based on current research, the science and the evidence are not where they could be ideally. She discussed marijuana and how it works, mentioning the endocannabinoid system. Different ways exist to act on that system. She described the entourage effect and how it functions.

D

Dr. Kim received his medical degree from SUNY Brooklyn and he completed a residency in both physical medicine and rehabilitation, along with a fellowship in anesthesiology and pain management at Mt. Sinai. He is board certified in both PM&R and anesthesiology.

In Part 1 of his presentation, he indicated that he would mention some specific products and companies, but he does not have a financial relationship with them. One of his objectives is to provide background information about PNS. Currently, there is an increase in this kind of technology and also in the demand for non-opioid pain management. PNS can be fitted into the specialty of neuro modulation, a field that touches upon multiple specialties, including PM&R. The basic goal in PNS is to stimulate the nerve and reduce unwanted pain. PNS has been around since the early 1960s.  Pain is the most common indicator for employing its usage. Dr. Kim has a specific interest in post-stroke shoulder pain, which is a difficult condition to treat. Post-surgical pain in general and post-amputation pain have led to the increased demand for PNS. Complications of this kind of treatment include the risk of infection and scarring around the nerve. Modern implantables show why PNS has increased in demand because technology has led to more miniaturization of these stimulators, which significantly has decreased the amount of invasiveness. Based on work performed at Rusk, he mentioned how research findings have been shared with professional organizations, such as the North American Neuromodulation Society (NANS).

In Part 2 of his presentation, he continued describing the current state of research on the use of PNS, which to some degree is lacking, but certainly it potentially is increasing. He referred to a multi-center, randomized, double-blind investigation that looked at PNS technologies in a variety of pain conditions. He then described a product that was cleared by the FDA in July 2016. It involves the use of multiple electronic leads rather than using a single one. The implant used is of a temporary nature (60 days) rather than something permanently. He pointed out that because the technology is much smaller, no incision is necessary. The micro lead is much smaller in diameter and does not have to be as close to the nerve. He showed a video about a typical implant for a shoulder, involving the 60-day version of technology being used. While it played, he narrated some of the steps shown in the video regarding the implant of the electrode. Everything becomes stabilized as the electrode moves closer to the nerve. His presentation concluded with his fielding questions asked by participants at this event, including two by Dr. Steven Flanagan, Director of the Rusk Rehabilitation Institute at NYU Langone Health.

Dr. Kim received his medical degree from SUNY Brooklyn and he completed a residency in both physical medicine and rehabilitation, along with a fellowship in anesthesiology and pain management at Mt. Sinai. He is board certified in both PM&R and anesthesiology.

In Part 1 of his presentation, he indicated that he would mention some specific products and companies, but he does not have a financial relationship with them. One of his objectives is to provide background information about PNS. Currently, there is an increase in this kind of technology and also in the demand for non-opioid pain management. PNS can be fitted into the specialty of neuro modulation, a field that touches upon multiple specialties, including PM&R. The basic goal in PNS is to stimulate the nerve and reduce unwanted pain. PNS has been around since the early 1960s.  Pain is the most common indicator for employing its usage. Dr. Kim has a specific interest in post-stroke shoulder pain, which is a difficult condition to treat. Post-surgical pain in general and post-amputation pain have led to the increased demand for PNS. Complications of this kind of treatment include the risk of infection and scarring around the nerve. Modern implantables show why PNS has increased in demand because technology has led to more miniaturization of these stimulators, which significantly has decreased the amount of invasiveness. Based on work performed at Rusk, he mentioned how research findings have been shared with professional organizations, such as the North American Neuromodulation Society (NANS).

In Part 2 of his presentation on the topic of diversity and inclusion in medicine, Dr. Lopez continued describing the use of a holistic approach to interview candidates for admission to NYU’s PM&R residency program. Factors currently being  taken into account other than board scores, include socio economic hardship, commitment to the underserved, work experience, and fluency in other languages. A task force also was formed to review every candidate individually. Interviews  presently involve taking a closer look at structured behavioral interview questions, which can be used to measure factors, such as professionalism and teamwork. Interviewers also are blinded to board scores to eliminate a higher halo effect that might exist. Dr. Lopez then reviewed the results of the latest match and identified the kinds of efforts that should be undertaken to increase the proportion of underrepresented groups, including women and members of the LGBTQ community. More diversity is welcome at NYU. Change is not going to happen overnight. Current efforts are just the starting point. A question and answer session for several minutes followed his presentation, including comments made by Dr. Steven Flanagan, Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at NYU Langone Health.

Note: The recruitment practices discussed in this episode were prior to the June 29, 2023 supreme court ruling on race as a specific basis for recruitment. Current practices have changed to follow federal, state and city guidelines.

In Part I, Dr. Lopez wanted to familiarize listeners in this grand rounds presentation with a history of minorities in medicine and to describe current trends in diversity and inclusion in medicine in general and specifically in PM&R.  He identified arguments for diversity and contrasted past, present, and future recruitment efforts at NYU. He also discussed this years’ match data results. Historically, there have been many challenges for minorities to gain a foothold in medicine. He wanted to furnish objective data about this situation. These individuals had a problem right from the beginning in obtaining admission to medical schools. He described enrollment data from the Association of American Medical Colleges (AAMC) and compared it to U.S. Census Bureau data. Over the last 50 years, Dr. Lopez noted how medical schools have tried to do something about increasing the proportion of students from underrepresented minority groups. Specific information entailed showing what has occurred in PM&R, involving students and faculty. Comparisons then were made with overall U.S. population trends. Reasons are provided for increasing diversity and inclusion in medicine, e.g., minority patients seek doctors who look like them and more minority physicians are likely to take care of minority patients.

Note: The recruitment practices discussed in this episode were prior to the June 29, 2023 supreme court ruling on race as a specific basis for recruitment. Current practices have changed to follow federal, state and city guidelines.

Dr. Ryan Branski is the Howard A. Rusk Associate Professor of Rehabilitation Research and the Vice Chair for Research in Rehabilitation Medicine at the NYU Grossman School of Medicine. He also has appointments in Otolaryngology-Head and Neck Surgery in the school of medicine and Communicative Sciences and Disorders in the Steinhardt School of Culture, Education, and Human Development. Dr. Branski runs a productive research enterprise encompassing both clinical and laboratory initiatives. His NIH-funded laboratory primarily focuses on wound healing and regenerative approaches to optimized healing in the upper aerodigestive track. Dr. Branski is one of only a few investigators to be named Fellow of the American Academy of Otolaryngology-Head and Neck Surgery, the American Speech Language Hearing Association, and the American Laryngological Association.

In Part 1 of his presentation, Dr. Branski discussed how efforts are underway to push research over the top in productivity at NYU. It is important to consider the economic implications of research. Obtaining external support is not easy and we should celebrate those accomplishments when funding is obtained. Voice disorders are the single most common communication disorder across the lifespan. He mentioned the importance of Reinke’s space and his contributions in describing the layered structure of the vocal folds. He indicated how challenging it is to deal with the problem of vocal fold necrosis. 

In Part 2 of his presentation, Dr. Branski discussed voice research, an area of investigation that not only poses the most opportunities, but also the most obstacles. He also mentioned developments in addressing tissue deficits in the airway. He closed on the theme that research needs to be opportunistic and that what is of value in this institution is to enhance communication between the thousand clinicians at NYU and the researchers. 

A Q & A period followed.

Dr. Ryan Branski is the Howard A. Rusk Associate Professor of Rehabilitation Research and the Vice Chair for Research in Rehabilitation Medicine at the NYU Grossman School of Medicine. He also has appointments in Otolaryngology-Head and Neck Surgery in the school of medicine and Communicative Sciences and Disorders in the Steinhardt School of Culture, Education, and Human Development. Dr. Branski runs a productive research enterprise encompassing both clinical and laboratory initiatives. His NIH-funded laboratory primarily focuses on wound healing and regenerative approaches to optimized healing in the upper aerodigestive track. Dr. Branski is one of only a few investigators to be named Fellow of the American Academy of Otolaryngology-Head and Neck Surgery, the American Speech Language Hearing Association, and the American Laryngological Association.

In Part 1 of his presentation, Dr. Branski discussed how efforts are underway to push research over the top in productivity at NYU. It is important to consider the economic implications of research. Obtaining external support is not easy and we should celebrate those accomplishments when funding is obtained. Voice disorders are the single most common communication disorder across the lifespan. He mentioned the importance of Reinke’s space and his contributions in describing the layered structure of the vocal folds. He indicated how challenging it is to deal with the problem of vocal fold necrosis. 

In Part 2 of his presentation, Dr. Branski discussed voice research, an area of investigation that not only poses the most opportunities, but also the most obstacles. He also mentioned developments in addressing tissue deficits in the airway. He closed on the theme that research needs to be opportunistic and that what is of value in this institution is to enhance communication between the thousand clinicians at NYU and the researchers. 

A Q & A period followed.

This is a special two-part Grand Rounds series with Dr. Steven Flanagan, Professor and Chairman of Rehabilitation Medicine and Medical Director of Rusk Rehabilitation. 

In Part 1 of his presentation, Dr. Flanagan discusses the contributions of Dr. Howard Rusk, the father of rehabilitation medicine. He brought it to the forefront as a recognized specialty by showing that rehabilitation contributed to improving the lives of patients with disabilities. Dr. Flanagan referred to various efforts over the decades to manage health care costs through managed care and other means. Even today when it is evident that a inpatient care is necessary, barriers can offer resistance because of the costs involved. What makes the case of inpatient care more challenging is the need to have more data to justify the decision to provide care at that level. He predicts that cost containment will continue well into the future. Our aims are to improve health care outcomes and increase efficiency. He concluded Part 1 of his presentation by stating that PM&R has a critical role to play in attaining the Triple Aim.

In Part 2 of his presentation, Dr. Flanagan discusses challenges involved in justifying the need for the provision of inpatient rehabilitation care in the context of controlling expenditures and the critical role that physical medicine and rehabilitation play in attaining the Triple Aim. We know that the intensity of some of our rehabilitation therapies are associated with better outcomes, for example, aphasia therapy. Early mobilization results in better outcomes with cost savings. Nonetheless, we still need more data to show that what we do is important. Mention was made of expansions at Rusk, such as a new division on Technology and Innovation to advance rehabilitation science. Health care is changing and education must change with it.

This is a special two-part Grand Rounds series with Dr. Steven Flanagan, Professor and Chairman of Rehabilitation Medicine and Medical Director of Rusk Rehabilitation. 

In Part 1 of his presentation, Dr. Flanagan discusses the contributions of Dr. Howard Rusk, the father of rehabilitation medicine. He brought it to the forefront as a recognized specialty by showing that rehabilitation contributed to improving the lives of patients with disabilities. Dr. Flanagan referred to various efforts over the decades to manage health care costs through managed care and other means. Even today when it is evident that a inpatient care is necessary, barriers can offer resistance because of the costs involved. What makes the case of inpatient care more challenging is the need to have more data to justify the decision to provide care at that level. He predicts that cost containment will continue well into the future. Our aims are to improve health care outcomes and increase efficiency. He concluded Part 1 of his presentation by stating that PM&R has a critical role to play in attaining the Triple Aim.

In Part 2 of his presentation, Dr. Flanagan discusses challenges involved in justifying the need for the provision of inpatient rehabilitation care in the context of controlling expenditures and the critical role that physical medicine and rehabilitation play in attaining the Triple Aim. We know that the intensity of some of our rehabilitation therapies are associated with better outcomes, for example, aphasia therapy. Early mobilization results in better outcomes with cost savings. Nonetheless, we still need more data to show that what we do is important. Mention was made of expansions at Rusk, such as a new division on Technology and Innovation to advance rehabilitation science. Health care is changing and education must change with it.

Dr. Mahya Beheshti is a physician scientist at NYU Langone Health’s Rusk Rehabilitation Institute. She has been working at the Visuomotor Integration Laboratory with the focus on eye-hand coordination research as it relates to acquired brain injury. She also collaborates with  the Rehabilitation Engineering Alliance and Center Transforming Low Vision Laboratory where her research involves advanced wearables for sensory deprived patients. Additionally, she is a Mechanical and Aerospace Engineering PhD student at NYU-Tandon.

Dr. J.R. Rizzo also is a physician scientist at NYU Langone Health’s Rusk Rehabilitation Institute. He serves as Director of Innovation and Technology for Physical Medicine and Rehabilitation with cross-appointments in the Department of Neurology and the Departments of Biomedical & Mechanical and Aerospace Engineering at NYU-Tandon. He also is the Associate Director of Healthcare for the renowned NYU Wireless Laboratory in the Department of Electrical and Computer Engineering at NYU-Tandon. He leads both the Visuomotor Integration Laboratory and the Rehabilitation Engineering Alliance and Center Transforming Low Vision Laboratory.

Dr. Mahya Beheshti is a physician scientist at NYU Langone Health’s Rusk Rehabilitation Institute. She has been working at the Visuomotor Integration Laboratory with the focus on eye-hand coordination research as it relates to acquired brain injury. She also collaborates with  the Rehabilitation Engineering Alliance and Center Transforming Low Vision Laboratory where her research involves advanced wearables for sensory deprived patients. Additionally, she is a Mechanical and Aerospace Engineering PhD student at NYU-Tandon.

Dr. J.R. Rizzo also is a physician scientist at NYU Langone Health’s Rusk Rehabilitation Institute. He serves as Director of Innovation and Technology for Physical Medicine and Rehabilitation with cross-appointments in the Department of Neurology and the Departments of Biomedical & Mechanical and Aerospace Engineering at NYU-Tandon. He also is the Associate Director of Healthcare for the renowned NYU Wireless Laboratory in the Department of Electrical and Computer Engineering at NYU-Tandon. He leads both the Visuomotor Integration Laboratory and the Rehabilitation Engineering Alliance and Center Transforming Low Vision Laboratory.

Dr. Robert Gordon is the Director of Intern Training and Associate Director of Postdoctoral Fellow Training at Rusk Rehabilitation Institute and Clinical Associate Professor at New York University Grossman School of Medicine. He has been the Director of Intern Training since 1995 and has trained over 270 psychology interns. He has specialties in the areas of neuropsychological and forensic testing and psychotherapy with children and adults with physical and learning disabilities and chronic illness. He has published in the areas of existential-humanistic and relational therapeutic approaches during COVID-19 with patients with preexisting conditions, ethics, supervision, relational psychoanalysis, dream interpretation, pain management, and the use of projective testing in neuropsychology. He received his doctorate from the Ferkauf Graduate School of Psychology, Yeshiva University in Child Clinical/School Psychology in 1985 and a Certificate in Psychoanalysis and Psychotherapy from Adelphi University in 1999. 

In Part 2, he discusses: some major techniques in applying Existential-Humanistic and Relational approaches with patients with preexisting medical conditions; what Posttraumatic Growth is and what strategies are used in exploring it in psychotherapy; major issues that patients with preexisting issues experience; kinds of therapeutic adjustments that must be made in treating patients with communication impairments; the nature of group work with patients and determining when it is advantageous to use it; and some implications of the paper he wrote regarding clinical practice and  society in general.

Dr. Robert Gordon is the Director of Intern Training and Associate Director of Postdoctoral Fellow Training at Rusk Rehabilitation Institute and Clinical Associate Professor at New York University Grossman School of Medicine. He has been the Director of Intern Training since 1995 and has trained over 270 psychology interns. He has specialties in the areas of neuropsychological and forensic testing and psychotherapy with children and adults with physical and learning disabilities and chronic illness. He has published in the areas of existential-humanistic and relational therapeutic approaches during COVID-19 with patients with preexisting conditions, ethics, supervision, relational psychoanalysis, dream interpretation, pain management, and the use of projective testing in neuropsychology. He received his doctorate from the Ferkauf Graduate School of Psychology, Yeshiva University in Child Clinical/School Psychology in 1985 and a Certificate in Psychoanalysis and Psychotherapy from Adelphi University in 1999. 

In Part 2, he discusses: some major techniques in applying Existential-Humanistic and Relational approaches with patients with preexisting medical conditions; what Posttraumatic Growth is and what strategies are used in exploring it in psychotherapy; major issues that patients with preexisting issues experience; kinds of therapeutic adjustments that must be made in treating patients with communication impairments; the nature of group work with patients and determining when it is advantageous to use it; and some implications of the paper he wrote regarding clinical practice and  society in general.

Dr. Joan Gold is a clinical professor in the Department of Rehabilitation at Rusk Rehabilitation, NYU Langone Health. Her medical degree is from the State University of New York Downstate Medical Center. She completed her residency in physical medicine and rehabilitation at the NYU Medical Center and her residency in pediatrics at Beth Israel Medical Center. She is board certified in the following three areas: Pediatric Rehabilitation Medicine, Physical Medicine & Rehabilitation, and also in Pediatrics. Her area of specialization includes the pediatric disorders cerebral palsy and spina bifida.

This is a special two-part Grand Rounds series.

In Part 1 of her presentation, Dr. Gold contrasted a time 50 years ago when she made a presentation on the topic of spina bifida. Today, we have a change in attitude and a change in medical information since that earlier period and we also need to be aware of long-term care needs and the need for continuity of care of these patients, and all our patients who are aging out. She cited professional literature from 1971 that described many kinds of pediatric patients whose conditions were such that rather than try to treat them, they should be allowed to succumb. For example, comments made back then about these patients being incontinent and socially unacceptable were not true. By 1996, it was shown that most of the previous assumptions were wrong. A child in a wheelchair is worth living. Many surgical deformities that once were present can be corrected today. Incontinence is not inevitable and bowel function can be controlled. She discussed the role of folate in reducing the incidence of spina bifida. She mentioned the implications of providing care for these patients. Most of the surgical procedures undertaken today are neurosurgical. Various generalizations can be made. One is that adult spina bifida patients are likely to have fewer primary care visits than patients under the age of 18 and she explained reasons why it is so. She concluded Part 1 of her presentation by talking about the role that urinary complications may play in the death of many patients.

Listeners to Part 1 of Dr. Gold’s presentation will recall she indicated that it probably is the urinary complication that is the cause of death in most of these patients, which is critical. In Part 2, she began by asking what multilevel care elements should exist for patients with spina bifida? She mentioned that as a result of pushing wheelchairs, some patients experience rotator cuff injuries. Although therapeutic services do not have to be performed for all patients, she described some kinds of assistance that they may need. Some patients may experience functional regression. Once able to walk at ages five and 10, they no longer can do so. There is a higher incidence of neuroses. These patients need vocational, nutritional, and social work services. A problem for many patients is when they have to travel a considerable distance for hospital care, the facility they go to may lack the personnel necessary to provide appropriate kinds of spina bifida care. She indicated some surgical concerns. Most shunted patients have long term motor and cognitive behavioral deficits. She described urological issues that are most paramount and frequent. She asked what kinds of things should we do when we assess patients within a therapeutic realm? We should look at their transportation skills, perceptual motor skills to drive, be knowledgeable of their medical management and history, and try to establish some autonomy with money management, household skills, and community living skills. Also, there is a need to work on their parenting skills and on obtaining adequate health care for themselves and their children. There are issues with cardiovascular disease. Studies show that as many as 73% of spina bifida patients have chronic pain. A final portion of the presentation was on the topic of women with spina bifida giving birth.

Dr. Joan Gold is a clinical professor in the Department of Rehabilitation at Rusk Rehabilitation, NYU Langone Health. Her medical degree is from the State University of New York Downstate Medical Center. She completed her residency in physical medicine and rehabilitation at the NYU Medical Center and her residency in pediatrics at Beth Israel Medical Center. She is board certified in the following three areas: Pediatric Rehabilitation Medicine, Physical Medicine & Rehabilitation, and also in Pediatrics. Her area of specialization includes the pediatric disorders cerebral palsy and spina bifida.

This is a special two-part Grand Rounds series.

In Part 1 of her presentation, Dr. Gold contrasted a time 50 years ago when she made a presentation on the topic of spina bifida. Today, we have a change in attitude and a change in medical information since that earlier period and we also need to be aware of long-term care needs and the need for continuity of care of these patients, and all our patients who are aging out. She cited professional literature from 1971 that described many kinds of pediatric patients whose conditions were such that rather than try to treat them, they should be allowed to succumb. For example, comments made back then about these patients being incontinent and socially unacceptable were not true. By 1996, it was shown that most of the previous assumptions were wrong. A child in a wheelchair is worth living. Many surgical deformities that once were present can be corrected today. Incontinence is not inevitable and bowel function can be controlled. She discussed the role of folate in reducing the incidence of spina bifida. She mentioned the implications of providing care for these patients. Most of the surgical procedures undertaken today are neurosurgical. Various generalizations can be made. One is that adult spina bifida patients are likely to have fewer primary care visits than patients under the age of 18 and she explained reasons why it is so. She concluded Part 1 of her presentation by talking about the role that urinary complications may play in the death of many patients.

Listeners to Part 1 of Dr. Gold’s presentation will recall she indicated that it probably is the urinary complication that is the cause of death in most of these patients, which is critical. In Part 2, she began by asking what multilevel care elements should exist for patients with spina bifida? She mentioned that as a result of pushing wheelchairs, some patients experience rotator cuff injuries. Although therapeutic services do not have to be performed for all patients, she described some kinds of assistance that they may need. Some patients may experience functional regression. Once able to walk at ages five and 10, they no longer can do so. There is a higher incidence of neuroses. These patients need vocational, nutritional, and social work services. A problem for many patients is when they have to travel a considerable distance for hospital care, the facility they go to may lack the personnel necessary to provide appropriate kinds of spina bifida care. She indicated some surgical concerns. Most shunted patients have long term motor and cognitive behavioral deficits. She described urological issues that are most paramount and frequent. She asked what kinds of things should we do when we assess patients within a therapeutic realm? We should look at their transportation skills, perceptual motor skills to drive, be knowledgeable of their medical management and history, and try to establish some autonomy with money management, household skills, and community living skills. Also, there is a need to work on their parenting skills and on obtaining adequate health care for themselves and their children. There are issues with cardiovascular disease. Studies show that as many as 73% of spina bifida patients have chronic pain. A final portion of the presentation was on the topic of women with spina bifida giving birth.